St Johns College

University of Cambridge

Application for admission to St. Johns College,

University of Cambridge

The John Crook Scholarship

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The closing date for receipt of applications is Monday, 6 November 2017.

Please submit the completed application form electronically to

john.crook.scholarship@joh.cam.ac.uk .

Then print a copy, sign and post the complete application pack with all attachments
to:
The Scholarship Administrator, The Senior Tutors Office, St Jons College,
Cambridge, CB2 1TP

The application pack should include:

Transcripts of your University qualifications giving details of the courses taken
and results obtained.
A recent sample of your academic work. This should be in the form of an essay
or other coursework.
Certificates of your secondary school qualifications. Insert a passport size photograph
Copies of letters from Student Finance England, for the duration of your
undergraduate studies.

E-mail the Applicant Recommendation Form to your two referees and ask them to send their references by the closing
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date of 6 November 2017, either by e-mail to john.crook.scholarship@joh.cam.ac.uk or by mail to the address given
above.
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It is expected that shortlisted candidates will be asked to attend an interview on Monday, 20 November 2017.

Proposed Course of Study at Cambridge University

Course: Degree (BA(Affil), MPhil, MAst):

Personal Details
Title: First Name: Surname:

Date of Birth: Place and Country of Birth: Nationality:

Marital Status: Children (number and their ages):

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St Johns College
University of Cambridge
Home Address: Correspondence address (if different):

Telephone number: Email address:

Secondary School Education

Name and Address of School:

Examination Results
Year Awarding Body Subject Level Result

Higher Education Current Studies

University Subject Degree Start Date Date to be Expected
obtained Grade

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University of Cambridge

Higher Education Previous Studies (starting with the most recent)

University Subject Degree Start Date End Date Grade

Scholarships / Prizes / Distinctions

Please note down the scholarships, prizes and/or other distinctions that you have been awarded.

Personal Statement
Please write a personal statement about your interests and your academic aspirations and how the John Crook
Scholarship and St Johns College will provide you with an education that will promote those aspirations. (Please do not
exceed a total of 500 words.)

John Crook Scholarship

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St Johns College
University of Cambridge

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St Johns College
University of Cambridge

Parent / Guardian Information

NB Please complete this section to the best of your knowledge, even if your parents are deceased.
Father / Guardian
Title: First Name: Surname:

Date of Birth: Place and Country of Birth: Nationality:

Occupation: Employment Status:

Academic Qualifications: Professional Qualifications: Address:

Mother / Guardian
Title: First Name: Surname:

Date of Birth: Place and Country of Birth: Nationality:

Occupation: Employment Status:

Academic Qualifications: Professional Qualifications: Address:

Please give details of Higher Education Qualifications obtained by any other members of your immediate family and state
their relationship to you:
Name Relationship to you Qualifications Year achieved

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St Johns College
University of Cambridge

Academic References
Please complete the details of two people acquainted with your academic work, whom you have asked to write on your
behalf, indicating your academic fitness and general suitability to undertake your proposed course.
Academic Referee 1
Title: First Name: Surname:

Institution: Position: Relationship to you:

Email Address: Address:

Academic Referee 2
Title: First Name: Surname:

Institution: Position: Relationship to you:

Email Address: Address:

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St Johns College
University of Cambridge

Funding of Studies
How have you funded your University education so far? (Please attach copies of the letters from Student Finance England)

How did you hear about the John Crook Scholarship?

Careers Services at your University St Johns College website
Poster Scholarship Hub website
Guardian website Director of Studies/Lecturer/Tutor
Google Search Other
If Other, please specify:

Signature
Signature: Date: .

Confidentiality: In accordance with the Data Protection Act 1998, all information will be treated in the strictest confidence
and will not be disclosed to anyone unconnected with the administration of the Scholarship Programmes at St Johns
College.

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