Please complete the form below and attach it - Sciences Po

Application form, Emile-Boutmy Scholarship
2012/2013
_____________________________________________________________________________________________
Please complete the form below and attach it to your application
with the requested documents.
Sciences Po created the Emile-Boutmy scholarship after the founder of Sciences Po (1871) in
order to attract the very best international students from outside of the European Union. The
Emile-Boutmy scholarship is awarded to top students whose profiles match the admissions
priorities of Sciences Po and individual course requirements.
Amount and duration of the scholarship
Please refer to Sciences Po’s website for further information on the amount and the duration of
the Emile-Boutmy scholarship:
http://formation.sciences-po.fr/en/contenu/the-emile-boutmy-scholarship
Reminder: eligibility
Eligible students are those from a non-European Union state, whose household does not file
taxes within the European Union, and who have been admitted to an Undergraduate or Master
programme.
This scholarship is awarded based on factors of excellence and according to the type of profile
sought for the programme to which you have applied. Social criteria are also taken into account.
This scholarship is not automatically awarded. A request for it must be made in the section
‘Attach documents’.
How to apply for the Emile-Boutmy scholarship
In order to apply for the Emile-Boutmy scholarship:
1/ Print and fill out the form below
2/ Attach it to your application form (with the requested documents: transcripts etc.)
Documents to be attached:
- Proof of income and documents explaining your family situation (e.g. income tax return
for both parents, payslips, divorce certificate, unemployment benefits, documents related
to alimony, child support or retirement pensions, death certificate, etc.).
Please make sure to provide the documents in the original language as well as a translation of
all documents into English or French (if you wish to translate the documents yourself, you may).
Without these documents, your application will not be considered.
____________________________________________________________________________
Emile-Boutmy scholarship 2012/2013 PAGE 1/2
Sciences Po Admissions
27 rue SaintGuillaume 75007 Paris +33(0)1 45 49 50 82

Application form, Emile-Boutmy Scholarship
2012/2013
_____________________________________________________________________________________________
Last name: ___________________________________________________________________
First name: ___________________________________________________________________
Date of Birth:__________________________________________________________________
Email address: ________________________________________________________________
Nationality 1:__________________________________________________________________
Nationality 2:__________________________________________________________________
Personal situation
Location of your household’s tax residency:
____________________________________________________________________________
Do your parents live separately
□ Yes
□ No
Profession of parent/guardian 1:
____________________________________________________________________________
Profession of parent/guardian 2:
____________________________________________________________________________
Number of dependent children (you included)
____________________________________________________________________________
Are your brothers and sisters enrolled in fulltime education
□ Yes
□ No
Please indicate their level of education:
____________________________________________________________________________
I hereby certify that the all the information in this application is true and complete to the
best of my knowledge, and that I alone completed this application. I am aware that the
scholarship will not be awarded if I cannot show the documentation supporting the
claims made in this application. False statements may lead to being expelled from
Sciences Po.
Date: ________________
Signature:
____________________________________________________________________________
Emile-Boutmy scholarship 2012/2013 PAGE 2/2
Sciences Po Admissions
27 rue SaintGuillaume 75007 Paris +33(0)1 45 49 50 82