Doctoral Thesis Writing Scholarship Application 2003-2004

Application for
Dissertation
Writing Scholarship
2003-2004
This form is for internal use only.
It is soley for the purpose of
assessing academic potential.
The Institute of Ismaili Studies
Information for Applicants
Applications are to be submitted to the following address by July 15th 2003:
Dissertation Writing Scholarship Committee
Department of Academic Research and Publications
The Institute of Ismaili Studies
42-44 Grosvenor Gardens
London SW1W 0EB
United Kingdom
Once completed, this application form must be accompanied by:
Letter of current standing in PhD programme
A current CV
Three academic references
PhD Research Proposal (2000 words)
Note: Applications submitted without the above documentation cannot be
considered by the Scholarship Committee.

Personal Details
Applicant's Full name
Surname or Family name
Address for
correspondence
First or Given name
Contact Details Telephone number (including full code)
Fax number
Applicant's Details
E-mail address
Date of Birth
Nationality
Country of Birth
Status
Immigration status if residing in other than country of nationality
Country of residence
Other addresses
Home address (if different from above)
Emergency Contact
Name
Telephone number (including full code)
Telephone number (including full code)
Please indicate the address above to which notification of outcome of the scholarship
application should be sent in August 2003.

Academic Details
What is the topic of research? What is the proposed title of dissertation?
*Please attach your PhD Proposal (max 2000 words) to this form.
Name and address of Institution and Department:
Name(s) of Supervisor(s):
Date of commencement:
Expected date of graduation:
Languages
Please indicate the languages
you speak, read and write fluently
Previous Applications
for funding Have your previously applied for a Doctoral scholarship from the Institute?
If so, when?
Yes
No
Have your previously applied for an Aga Khan Educational Services Scholarship
or an Aga Khan Foundation Scholarship?
If so, when?
Yes
No
What was the outcome?
Office Use Only
Date received: Date boarded: Result: Date notified: