CHRISTINA McCONNELL SCHOLARSHIP APPLICATION (Ugandan Nationals Only)

Transcription

1 CHRISTINA McCONNELL SCHOLARSHIP APPLICATION (Ugandan Nationals Only) TYPE OR CLEARLY PRINT ALL INFORMATION IN BLACK/BLUE INK. All four parts of the application must be completed and submitted with a copy of the birth certificate/passport by February 25 th, Incomplete applications will not be forwarded to the scholarship committee. This Scholarship application form has been designed to give each applicant fair and equal consideration. The scholarship is awarded based on financial need and student merit. Please complete the form as accurately as possible and return via to ssprincipal@isumail.ac.ug. Place current passport size photo here All information given will be held in strict confidence and will be used by school officials only. An incomplete application will not be considered. PART 1. PERSONAL INFORMATION STUDENT INFORMATION Student s full name Surname Other Names Male Female Age Birth Date (MM/DD/YYYY) Place of Birth: Region District Sub County Village Country of Birth Nationality Do you have a birth certificate or passport? If Yes, please provide details Current Address: P.O Box City: Region/Sub County: Telephone (student): (student): What languages do you speak? Fluent in English? Yes No Have you lived or studied in another country? If yes, please describe: Areas of specific academic interest:

2 PARENT / GUARDIAN INFORMATION (if deceased include date of death) Father/Guardian s Name Mother/Guardian s Name Father/Guardian s Nationality Father/Guardian s ID Number Telephone Contacts address Father/Guardian s Address (if different from applicant) Mother/Guardian s Nationality Mother/Guardian s ID Number Telephone Contacts address Mother/Guardian s Address (if different from applicant) Please list the preferred address for receiving communication from ISU Other family members: Sisters (and ages): Brothers (and ages): Other: Who has legal custody of the student? RESIDENCE With whom does the student live with in Uganda? Name: Relationship to student: (E.g. mother, father, guardian, grandparents) Place of Residence: Name & Telephone Contact of LC1 Chairperson: EMERGENCY CONTACT INFORMATION IN KAMPALA Please name an adult in Kampala, other than the parents/guardians, who can be contacted in case of an EMERGENCY. Name: Relationship: Physical Address in Kampala: P. O. Box: Telephone Contact: Mobile: address:

3 EDUCATION BACKGROUND Name of School Currently Attending or where you did your UCE exams Current Class / Form in School School Address School Telephone School Address School Principal / Headmaster Name School ID Number Who currently pays your school fees? (In the case of an organisation please state name and contact details) What were your results in the 2017 UCE exams? English Maths Biology Chemistry Physics History Geography Commerce Other Total Aggregate: Grade: PART 2. WRITTEN TASKS The application packet is incomplete without the responses to each of these items. For each prompt, use the allocated space or submit a separate document identifying each written part to which you are responding to (include your name and school on every page). Your work should be neat, grammatically correct, and demonstrate proficiency in English. Extra Curricular Activities please list all activities you participated in at school e.g. football/netball, track and field, drama, music, etc.

4 Leadership do you / have you held a leadership position within your school or community e.g. team captain. Future Goals what is your career ambition and why? Future Goals where do you see yourself in 10 years time? PART 3. SCHOOL REPORT / TRANSCRIPTS / DOCUMENTATION Please ask your school to provide you with a copy of your academic records to date. This should list the classes that you have taken and your final scores for each class you have completed in the last three years. Please attach this and the following to this application: 1. O Level UCE certificate certified copies 2. Past school reports - certified copies 3. School ID copy 4. Birth Certificate / Passport copy 5. Letter of recommendation from current School Principal / Headmaster 6. Character reference from recommending organisation (required for initial application)

5 PART 4. FINANCIAL INFORMATION Total Household Income Per Year Family Assets and Value Household Liabilities / Loans Cost of Student Education Other information How did you learn about the ISU Scholarship? Newspaper ISU Website Notice Board Social Media Word of Mouth Other (please specify) STUDENT APPLICANT S STATEMENT AND SIGNATURE: I certify that to the best of my knowledge all the information I have provided is accurate and that the work I have submitted is my own. APPLICANT S SIGNATURE: PARENT / GUARDIAN S STATEMENT AND SIGNATURE: I certify that the information I have given is true in all respects and that I understand that if any information so given is found to be false, the Scholarship will cease immediately and the school will take whatever action necessary to recover amounts disbursed. I understand that if given the Scholarship the student will be required to meet requirements for academic work and appropriate behaviour. I understand that the approval of a Scholarship for this year in no way obligates ISU to continue with scholarships in subsequent years. Each year renewals will be made and set on the basis of the demonstrated applicant s achievements. FATHER / GUARDIAN S SIGNATURE: MOTHER / GUARDIAN S SIGNATURE: