Postgraduate Application Form

CARRERAS 2015/2017 POST GRADUATE SCHOLARSHIP
APPLICATION FORM
Read carefully and complete all sections of this form as applicable
HIGHER
SECTION A – CONTACT INFORMATION
1.
First Name: ______________
2.
Sex: M 
3.
Nationality: ____________________________
4.
Parish of Birth: _________________________
5.
Address: ______________________________________________________________________
F
Middle Name: _______________
Age: ____________
Surname: _______________
Date of Birth: ______/______/_________
DD
MM
YYYY
______________________________________________________________________________
6.
Mailing Address (if different from above): ___________________________________________
______________________________________________________________________________
7.
Home Number: _______________________
8.
Email Address: _________________________________________________________________
Cell Number: ___________________________
______________________________________________________________________________
SECTION B – DETAILS OF PROGRAMME
1. Name Institution/University you are currently enrolled in …………………………………………
2.
Course of study: ………..............................……………………………………………………….
3.
Duration of study: …............................…………………………………………………………….
Have you previously been awarded any scholarship or bursary in connection with your present
course of study? Yes [ ] No [ ] - If yes, please supply details:
4.
….. …………………………………………………………………………………………..
……………………………………………………………………………………………….
4.1
How are you presently being supported with your college expenses?
Student Loan [ ]
Other
Boarding Grant [ ]
Parental Support [ ]
[ ] please state …………………………………………………………
SECTION C - YOUR EDUCATION (INCLUDING TRAINING COURSES)
5. Undergraduate Qualifications (all applicants)
a) Please give details of your undergraduate qualifications including Honours and attach originals (or certified copies*
of) Transcripts giving subject details and results.
Qualification Level of
Qualification
Level of Honours
Institution/
Duration of study
Completed Yes/No
Obtained
University and
Location
SECTION D – LEADERSHIP & VOLUNTEERISM
1. List any leadership positions or offices held during your educational/or professional career:
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
2. List any clubs or societies that you have been a member of during your educational/or
professional career:
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
3.
Have you participated in community/voluntary service? Yes [
assistance did you provide and when?
]
No [
] - If yes, what kind of
Date:_____________________
…………………………………………………………………………………………………… …...
………………………………………………………………………………………………………….
SECTION E – REFERENCES
1. Please give the names of two referees, preferably persons who have taught or worked with you.
a. Name: ________________________________________________
Position: __________________________
Institution: ______________
Address: ___________________________________
Tel: ________________
b. Name: _________________________________________________
Position: ___________________________
Institution: _________________
Address: __________________________________
Tel: ________________
2. State, in no more than 200 words, your career goals and the benefits you hope to gain from successful
training.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3.
___________________________________ (Attach additional page, if necessary)
Any other information which you consider relevant to this application:
______________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________ (Attach additional page, if necessary)
Statistical information (scholarship applicants)
Where did you hear about the scholarships?
On-campus: _______________________
Newspaper:-_________________________
Previous Scholarship Awardee: ______________________ Other : __________________
Application Checklist
In order to expedite your application, please ensure that the following checklist is complete
prior to the submission of your application.
1.
ONE copy [certified] of your official academic transcript, showing academic
background (at least an Upper Second Class degree or equivalent at the time of
application) and Extra-Curricular activities at university level
2. Statement of purpose of study
3. Evidence of acceptance for postgraduate studies at a college/university
4.
ONE copy (certified) of your birth certificate, or other document showing
evidence of age and nationality (Passport or Driver’s Licence)
5. ONE copy of your resume
6. TWO Letters of reference
Signature: ________________________________________
Date: ________________________________________
This Application Form can be returned to:
Carreras Limited
13a Ripon Road
Kingston 5