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Scholarship Application Form

By Natalie-Henry Apr 23, 2015 785 Words
UNDERGRADUATE PROGRAMME
SCHOLARSHIP APPLICATION FORM

PHOTOS

2 recent passport size photos

INSTRUCTIONS:
1. Please read the form carefully and complete the relevant sections; 2. Do not write in the shaded areas.
3. This form should be submitted with:
 A non-refundable fee of $300.00
 Two (2) Passport Size Photographs,
 *Certificates: CXC / GCE, Diploma or Associate Degree (transcripts applicable for tertiary certification)
 *Birth Certificate
 *Marriage Certificate (if applicable),
 An Essay: Why should you be accepted for this programme and how will you use it to your benefit and the wider society
 Two (2) Referee Reports
*copies along with originals should be submitted for verification

[FOR OFFICE USE ONLY]

Id number:
___________________________

PERSONAL DETAILS:
Name: ___________________________________________________________________________ Surname

Christian

Middle

Maiden Name: (where applicable) _______________________________________________

Sex: ☐ Male

☐ Female

Name to be used for official records: _______________________________________________________________________________ Permanent Address: (Home) _______________________________________________________________________________________ ___________________________________________________________________________________________________________________ Mailing Address: (if different from above) ________________________________________________________________________________ ___________________________________________________________________________________________________________________ E-mail address: __________________________________________________________________________________________________ Telephone: (Home) ___________________________ (Work) ___________________________ (Mobile) _________________________ Present Occupation: ______________________________________________________________________________________________ Place of Employment (Name & Address): __________________________________________________________________________ ___________________________________________________________________________________________________________________ Date of Birth: ______/_________/_________

Year

Month

Day

Marital Status:
(Please Tick)


Single





Married

Divorced


Widowed

Nationality: ________________________________________

Religious Denomination: ____________________________________

Next of Kin: _______________________________________

Relationship: ________________________________[In case of emergency]

Contact # (Kin): Home) _____________________ (Work) _____________________ (Mobile) ________________________________

[FOR OFFICIAL USE ONLY]

PAYMENT INFORMATION

Receipt no.:_________________________

Amount ($): _________________________________

Date Received: _______________________

Signature: ___________________________________

PROGRAMME INFO:
First option: Please tick ( )
 Bachelor of Arts in Theology

 Bachelor of Science in Hospitality Management

 Bachelor of Arts in Guidance and Counselling

 Bachelor of Science in Nursing

 Bachelor of Education (Primary)

Associate in Business Administration

 Bachelor of Education (Early Childhood Education)

 Associate in Programme and Project Management

 Bachelor of Arts in General Studies

 Associate in Business Administration with Programme and

 Bachelor of Arts in Community Development

Project Management
 Associate in Business Administration with Management and

 Bachelor of Arts in Psychology
 Bachelor of Arts in Media & Communication Arts

Information Systems

 Bachelor of Science in Human Resource Management

 Diploma in Early childhood Education

 Bachelor of Science in Business Administration

 Diploma in Theology

 Bachelor of Science in Programme and Project Management

 Diploma in Early Childhood Education

 Bachelor of Science in Business Administration with

 Certificate in Theology
 Certificate in Lay Pastors and Leaders Training

Programme and Project Management

Second Option: (Please indicate your second option on the line below) ___________________________________________________________________________

Location of Study:
SURREY:

CORNWALL:

NORTH MIDDLESEX:

SOUTH MIDDLESEX:

CAYMAN:

 Central (Kingston)
 Portmore
 Oberlin

 Montego Bay
 Savanna-La-Mar
 Trelawny
 Sandy Bay
.Browns Town

 Tower Isle Campus
 Tacky
 Whitehall

 Mandeville
 Santa Cruz
 May Pen
 Kellits
 Old Harbour

 Grand Cayman

PORT ANTONIO
 Snow Hill Campus

MODE OF STUDY:

☐Part time

☐Full Time

APPLYING AS A:

☐Tertiary Track Scholarship

☐First Steps Scholarship

DO YOU HAVE ANY DISABILITIES:

☐ YES

☐ NO

If yes please specify_____________________________________________________________________________________ (Please provide documentation as to the type and degree of disability)

HOW DID YOU OBTAIN INFORMATION ABOUT IUC (CLTD/MNC)? (Tick all that apply)

☐ College Fair / Expo

☐ School Visit

☐Media

☐ Website

Please indicate the name of the referee for the following categories: Employer _________________________________________________________________________________________________________ IUC Alumnae _____________________________________________________________________________________________________ IUC Student ______________________________________________________________________________________________________ IUC Staff _________________________________________________________________________________________________________ Other ____________________________________________________________________________________________________________

FOR IDENTIFICATION CARD PURPOSE
Instructions: Kindly sign in the box provided below. Please avoid touching the borders when signing.

-2-

Updated June 2011 / nf

EDUCATIONAL BACKGROUND:
INSTITUTION

CERTIFICATION

DURATION (SPECIFY YEARS)

Other training received: ____________________________________________________________________________________________ ____________________________________________________________________________________________________________________

WORK EXPERIENCE: (List most recent first)
EMPLOYER

POSITION

DURATION (SPECIFY YEARS)

Voluntary/informal work experience:
____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

PERSONAL EXPERIENCE
Please indicate any other information about yourself which might help us to know you better (hobbies, family background, other interests or experiences, etc.
____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

RELEASE FORM
I, _________________________________ hereby give permission to the International University of the Caribbean (IUC) [Mel Nathan College or the College for Leadership and Theological Development (formerly Institute for Theological and Leadership Development)] to use or display my photograph, if desired, in University publications or in any advertisement of the University and its courses.

______________________________________ (Signature)

______________________________________ (Date)

-3-

Updated June 2011 / nf

REFERENCE INFORMATION**
(Please give the names of two persons – one of whom should be your present Supervisor/Employer –who can provide information about you.)

1.

Name of Referee:________________________________________________________________________________________________ Position/Title: ____________________________________________________________________________________________________ Address: ________________________________________________________________________________________________________ Telephone: (Home) ________________________ Office: _____________________

2.

Cell #: ________________________________

Name of Referee: _______________________________________________________________________________________________ Position/Title: ____________________________________________________________________________________________________ Address: ________________________________________________________________________________________________________ Telephone: (Home) ________________________ Office: _____________________

Cell #: ________________________________

**Referee forms are available online or in office

[FOR OFFICE USE ONLY]
Application Received: __________________________________ (Date) Photographs

Certificates

Transcripts

Statement
of Purpose

Birth Cert.

Marriage
Cert.

Referees’
Reports

Documents
Received:















Documents
Pending:

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