HMC PROJECTS SCHOLARSHIP PROGRAMME 2019

ROMANIA

Application Form
(Please, read the information on the instructions document before you fill and submit this form.)

A. Personal Information.

First name, second name and family name  Prefer to be called 

PHOTO
Date of Birth (e.g. September 20th 2002)  Sex [M or F]
Replace the text in this cell
Place of Birth  (town/city) Country of Birth  with a recent digital
passport-style photograph
of yourself taken during the
Full Home Address  (Street, No., block, etc.) last year.

City/Town  Postal Code 

Phone (Home)  Phone (Mobile) 

(country code, city code, (country code, number) E-mail 
number)

Country of Citizenship  Nationality 

B. Education.

Full Name of school you attend (in English)  (+ city/town)

Full Name of school you attend (in your language, if different) (+ city/town)

Name of Head/Principal 
Type: [Public or Private] 
Type of School

School specialism: [General, Classical, Science or Bilingual] 

*If Bilingual (some subjects taught in a foreign language), state in which language(s).
In what year will you finish secondary education? 

Started Finished
School name + city/town Public/Private Bilingual?
(year) (year)
Previous
schools


C. Languages.
Hours per
Language How many years? Course: [School or Private] Grades/scores
week

English

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D. Academic, Extracurricular And Personal Interests.
In the UK most A Level students start with three or four subjects. Please check the advice we give in the further
information and then list the three or four subjects that you would most like to study. Also list the academic
awards/honours you have won in the past three years (if any).: 

List the current sports (athletic activities) that you play and for how long (Note team, position, prizes won, if any): 

List the current performing and visual art forms that interest you the most and in which you participate. (Note any
instrument you play; choir/band/orchestra to which you belong; dance/ theatre group; painting, drawing,
photography, etc. and for how long).Please note any awards you have won during the last three years. 

List the clubs, organizations or community service groups to which you belong – not only within the school but also
outside school. (Note how long you have been involved, the purpose of the group, and your role in it.) 

What field of study or future career are you considering? 

Have you spent more than one month in a western country? If yes, where, when and how long? 

What three words would you choose to describe yourself? 

E. Programme Preference.
We ask that you to state which scholarship programme you wish to be considered for. This
helps the interviewers a great deal and does not influence your selection for a scholarship.

Please read the notes about eligibility for a full scholarship carefully before completing this section.

Scholarship type Choice

HMC full scholarship [Yes or No]

HMC reduced fee scholarship [Yes or No]

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F. Family Information.
Father Mother
Parents Name in Full 

[Living or Deceased]  [Living or Deceased] 

[Together, Separated or Divorced] 
Name of Step-parents (if applicable)


Full Home Address 

(City, postal code, Street, No.)

Telephone 
(Country code, city code, number)
Mobile Phone 
(country code, number)
E-mail 

Profession 

Employer 
Work phone, if applicable (Country
code, city code, number)

Brothers and sisters

Living at Home? Participated in this
Name Sex [F or M] Age Occupation
[Y or N] program? [Y or N]

If you have friends or relatives in the UK please provide their full name, relationship, and address: 

Please write in your own handwriting the following statement:

My signature below indicates that all the information given is complete and correct to the best of
my knowledge, and the essay is my work alone.
____________________________________________________________________________________
____________________________________________________________________________________

Signature (of applicant) ______________________ Date _______________

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 HMC PROJECTS SCHOLARSHIP PROGRAMME
2019 ROMANIA

Statements
Full Name of Applicant

Name of Male Parent or Guardian

Name of Female Parent or Guardian

To be signed by parents or guardians of ALL applicants

As the parent or guardian of the above-named candidate:

 I agree that my son/daughter will be an applicant for a Scholarship through HMC Projects.
 I have read and understand the paper titled “Information for Parents” giving details of the general arrangements
for my son or daughter to take up a scholarship at a school in the United Kingdom.
 I give my provisional agreement for my son/daughter to be nominated to a school for a scholarship for the
academic year starting September 2019 and I understand that shall be asked by the school to sign the normal
forms of agreement with them.
 I agree that the Contact Person nominated by the School may act on my behalf to make suitable arrangements
for my son/daughter when the school is closed during term-time. These arrangements may include independent
travel in Great Britain.
 I understand and agree that I will pay an administrative fee of £1400 towards my son’s/daughter’s scholarship
if he/she is selected for a full scholarship through HMC Projects. The deadline for payment is 1st July 2019.
 I understand that any extension of the scholarship into a second year is entirely at the discretion of the school
offering a scholarship place.
 I have read, understand and agree to what is set out in the section in the Information for Parents “Your and
your son’s/daughter’s data and how we use it”.

Signature of Male Parent or Guardian Signature of Female Parent or Guardian Date

Also, to be signed by parents or guardians of applicants applying for a FULL scholarship

As the parent or guardian of the above-named candidate who is applying for a full scholarship, I confirm that total
parental income during 2018 will not exceed the equivalent of £30,000.

Signature of Male Parent or Guardian Signature of Female Parent or Guardian Date

Please note:
Those candidates selected for interview for a scholarship will be required to complete a parental income
declaration form.

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 Health Declaration

To be completed by the applicant’s parent(s) or legal guardian

Please answer the following questions about state of health of your son/daughter and provide any extra information
or detail which may be relevant.

Question Answer

Is your son/daughter in good health? [Yes or No]

If no, please give details 

Is he/she is currently protected by immunisation from MMR

[Yes or No]
(Measles, Mumps and Rubella, Polio and Tetanus)?

During the past five years has he/she received hospital treatment
[Yes or No]
for any operation or condition?

If yes, please give details 

Does he/she currently have any medical conditions? [Yes or No]

If yes, please give details 

Is your son/daughter at present receiving medical or psychological

[Yes or No]
treatment for any condition, except those named above?

If yes, please give details 

Does he/she have any medical or psychological problem known to

[Yes or No]
you which may require specialist or hospital treatment?

If yes, please give details 

Signature of Male Parent or Guardian Signature of Female Parent or Guardian Date

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 School Grades

Please enter your school grades (1-10) from your school reports for your last class and
your current class into the subject table below.
If a subject is not in the list then please enter the subject and the grade(s) in a blank row.

Grades (1-10)
Subjects Disciplinele de învăţământ Previous Current
Class Class

Behaviour Purtare

Romanian language and literature Limba şi literatura română

English Limba engleză
French Limba franceză
German Limba germana
Latin Limba latină
Mathematics Matematică
Physics Fizică
Chemistry Chimie
Biology Biologie
Civic culture Cultură civică
History Istorie
Geography Geografie
Art Educaţie plastică
Music Educaţie muzicală
Technology Educaţie tehnologică
Computer science Informatică
Tehnologia informaţiei şi a
ICT
comunicării
Psychology Psihologie
Economics Economie
Philosophy Filosofie
Religion Religie
Physical education Educaţie fizică

Optional subjects Disciplinele opţionale

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Personal essay:
Please type your personal essay of between 750 and 1000 words on this page and then sign the declaration below:

I declare that this essay is entirely my own work. (signed) _____________________________________

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