SCHOLARSHIP APPLICATION FORM

for the period 1st October 2013 till 30th September 2014
 
to be filled out typed, in English or in French, in triplicate
January 15th 2013 at the latest.
 
     SIE Scholarship
     Dr. Suzanne Noël Scholarship

1 Presenting Union / Single Club

Name of Union                

     

Name of Club

     		 Name of Single Club
     
2 Applicant’s Status
 Soroptimist
Starting year
     		  Non-Soroptimist
What is your connection to the club presenting you?
     
3 Personal data
Name in full (Family name, First names)
     ,      
Date of birth       Place of birth (Country)      
Marital Status       Children     
Country of Citizenship (passport)
     
Permanent Address
     
Telephone / Mobile
     
E-mail
     
4 Purpose of Scholarship / Grant
 1. Supporting women in profession undertaking continuing education within their present chosen profession/vocation; regardless of educational level or discipline.
 2. Supporting women in profession undertaking a pending career change; regardless of educational level or discipline.
 3. Supporting women from developing countries with an existing SI/E Club, towards professional and/or vocational training.
 
 Dr.Suzanne Noël Fund:This fund aims at giving a financial help to a female doctor willing to perfect her knowledge and experiments regarding plastic and restoring surgery.
 
Note: Preference might be given to applicants attending the last year of their studies or training courses.
5 CURRICULUM VITAE
Present occupation or employment
     
 
 Full-time        Part-time      Start (mm/yy):      
Previous employments(last or 3 most relevant)
Job title Employer Full-time Part-time Dates (mm/yy)
start - finish
                     -      
                     -      
                     -      
Educational, professional / technical or other qualifications(degrees, diplomas, certificates, licenses, etc. where and when received) - no more than 3 most relevant
Qualification Where received (Institute and Country) When (mm/yy) – latest first
                 
                 
                 
Other information(e.g. prizes, grants, articles, exhibitions) * see instructions
     
Languages spoken, onlyif relevant concerning this application (indicate proficiency) * see Appendix: InstRuctions and conditions
     
             

6 Programme of study or training for which the scholarship/grant is requested
Study Programme / training
Title:      
Establishment / Institution where studies would be undertaken
Name:                
Adresse:            
Website:             
Candidate has been accepted: Yes (add document of acceptance)              No
If not, document of acceptance has to be sent not later than by the end of March 2013to the Committee Chairman.
 
Start and duration of the whole study programme / training:
     -      (mm/yy – mm/yy) (give proof of ongoing studies/taining)
Period to be covered by the SI/E scholarship/grant  (maximum one year: 1st October 2013 – 30th September 2014)
       -        (mm/yy – mm/yy)
Impact of study programme or training on you and how do you expect to use the newly gained experience and / or knowledge or the benefit of your career and the society?
 
7 Budget of the Study Programme / Training
Total costs of the studies/training in Euros for the period to be covered by the SI/E scholarship/grant
*see Appendix: InstRuctions and conditions
 Registration fees €     
 Tuition fees €     
 Housing, living expenses €     
 Books, software, paper €     
 Health and Insurance €     
 Other costs(detailed)
 
 		 €     
                                                                                                                              Total
 
NOTE : Costs which are not accepted:
Hardware (computer etc.)
Travel costs between countries		 €     
What amount in Euros do you apply for (no more than 15 000 Euros)? €     
If you need more than the maximum amount of the Soroptimist scholarship/grant to carry out your programme, how will you cover these costs?
     
Do you get other scholarships/grants?
Period covered        -      (mm/yy – mm/yy)
Amount                       Euros

8 Signature by the Applicant
I, the undersigned, hereby certify that all information given in this application is complete and accurate to the best of my knowledge. I have attached all required documents and have provided for the necessary papers to be forwarded to the President of the sponsoring Soroptimist Club.
 
I agree to all the terms and conditions governing this scholarship/grant given in the Appendix: InstRuctions and conditions.
Signature of the Applicant Date
 
 		      
The following documents belonging to the application have to be attached/enclosed:
  • Applicant’s letter of presentation
  • Recommendation by a professional person
  • Recommendation by a Soroptimist of the nominating Club and/or by the President of this Club
  • Document of acceptance
 Other documents (list):

 

9 Endorsement of Unions / Single Clubs

Union Endorsement
     (name of candidate) who has been proposed by the Club of      (name of the Club) is presented as a candidate for a SI/E scholarship/grant by the Union of      .
The Union President or the Scholarship Committee Chairman of the Union forwards this application to the SI/E Scholarship Committee Chairman 2011-2013:
Annabeth Studer
Allwinden 4
CH-6047 Kastanienbaum
Switzerland
January 15th 2013at the latest!!!
Name (Union President) (please print)
     
e-mail:      		 Date
     
Signature
 
 
Name(Union Scholarship Committee Chair)(please print)
     
e-mail:      		 Date
     
Signature
 
 
Club Endorsement
Name (President of sponsoring Club)(please print)
     
e-mail:      		 Date
     
Signature
 
 

 or

Single Club Endorsement
     (name of candidate) is presented as a candidate for a SI/E scholarship/grant by the Single Club of      (name of Single Club).
The President of the Single Club forwards this application to the SI/E Scholarship Committee Chairman 2011-2013:
Annabeth Studer
Allwinden 4
CH-6047 Kastanienbaum
Switzerland
                                                                                                        January 15th 2013 at the latest!!!
Name (Single Club President)(please print)
     
e-mail:      		 Date
     
Signature
 
 

 

SI/E Scholarship Fund and Dr. Suzanne Noël Scholarship Fund
Appendix: INSTRUCTIONS and conditions for Applicants
 
General information

  • Use the Scholarship Application Form for the period 2013-2014.
  • The application must be typed in English or French.
  • The application must be transmitted, including all supplementary sheets, and other relevant documents, in triplicate and, as for the application form, electronically to the nominating Club President.
  • Questions must be answered fully.
  • Do not use abbreviations.
  • All certificates and recommendations in languages other than English or French must be accompanied by a translation.
  • Handling the electronic form:
    - when using the electronic form, space will increase as you type;
    - when printing a paper copy of the electronic form, increase the space before printing it;
    - when typing on a printed form, if space is insufficient, attach supplementary sheets, write your name on every supplementary sheet, and indicate the subject.

 
Dr. Suzanne Noël Scholarship
CONDITIONS REQUIRED FROM THE CANDIDATE

  • To be under 50,
  • To be qualified to practise medicine,
  • To be already rather specialised in plastic surgery, if not, be preparing a thesis on plastic and restoring surgery,
  • To present a written certificate from a plastic surgeon, member of the association of surgeons specialised in plastic and restoring surgery from the country which presents the candidate

 
Curriculum vitae (5)

  • Other information: such as prizes, grants, publications, articles, exhibitions, videos, musical recordings, personal grants that are relevant for your study programmeor training.
  • A language certificate, issued by a qualified person or institution, is needed if you wish to study in a country where the language is different from your own.

 
Budget (7)

  • All costs have to be documented. Give details of all fees. Other expenses have to be listed in detail as far as possible.

 
Signature (8)

  • The application has to include a short letter of presentation and CV.
  • An applicant needs a letter of recommendation from a member of her profession/vocation.
  • An applicant needs a letter of recommendation from a Soroptimist of the nominating Club and/or from the President of this Club.

 
Before signing your application, read the following conditions:

  • If granted a scholarship/grant by Soroptimist International of Europe, I will:
  • inform myself about Soroptimist International,
  • be in contact with the nominating Soroptimist Club,
  • be ready to commence and proceed with my studies without undue delay, at the time stated on my programme, and in any case within the 1st of October 2013 when the grant was assigned, and the 30th of September 2014,
  • refund the sum received for the amount I did not utilise, as soon as possible, in case I become physically or otherwise unable to carry out my commitments, and
  • submit a final report to the nominating Club at the end of the study period and not later than December 31st 2014. (You will get the SI/E Scholarship Final ReportForm from the Club when granted.
  • agree to have published my final report, eventually with pictures, in the LINK (quarterly periodical of SI/E), on demand of the Scholarship Committee.