SCHOLARSHIP APPLICATION FORM The Henley and Partners Hero Scholarship* Managed by The Halo Foundation, Inc. TENABLE ONLY AT ST.MARY S UNIVERSITY, HALIFAX, NOVA SCOTIA, CANADA Eligibility: Any person in their final year of secondary school. (Fifth form) Any person attending a tertiary institution. (Antigua State College/ABIIT etc.) Any person who has graduated from a secondary or tertiary institution within the past eight years. Should be 16-25 years at the time of application. Must be a national of Antigua and Barbuda. Can be identified as deserving of recognition in the area of humanitarian efforts, specifically with respect to acts of bravery and kindness. Application Process: Each student must complete this application form and submit the following documents: A passport sized photo. Certified copy of valid passport. Certified copy of birth certificate. Certified copy of all academic certificates. (CSEC, CAPE, IB Diploma etc.) Recent academic transcripts. Three (3) letters of recommendation from three (3) separate sources, not including relatives, to verify their involvement in humanitarian efforts, or exceptional acts of bravery or kindness. Letters can be submitted by teachers, friends, religious leaders or employers. Educational Requirements: All persons applying for this scholarship must have the below mentioned educational qualifications: Minimum of six (6) CXC subjects with grades 1 and 2 IB program: Minimum IB diploma score of 24 with grades of 3 and above in prerequisite subjects. Minimum of three (3) CAPE subjects with grades 1, 2, or 3. The Scholarship Awardee will also be presented with the Halo Hero Medal for Humanity by Lady Sandra Williams, Founder of The Halo Foundation, Inc. All applications should be submitted with all supplementary documentation to the Government House by July 29, 2016. *Certification of documents does not have to be done by a Lawyer or Notary Public. Any person who is an Officer of the Ministry of Education, Antigua State College, ABIIT, UWI Open Campus, Ministers of Religion, School Principals, Senor Officers in Educational Institutions, Executive Managers and other professionals may certify copies of documents as having seen the originals.
APPLICATION INSTRUCTIONS: Complete all sections of this form. Attach all supplementary documentation Deadline is July 29, 2016. Please STAPLE, not paste, a recent passport sized photo in the box provided. Print your name on the back of the photo before stapling to the form. PERSONAL INFORMATION (Please Print) Full Name: Address: Date of Birth: (DD/MM/YYYY) / / Place of Birth: Nationality: Telephone No.: Home: ( ) Cell: ( ) Work: ( ) Email address: PARENT INFORMATION (Please Print) Mother s Name: Address: Occupation: Place of Employment: Telephone No.: Home: ( ) Cell: ( ) Work: ( ) Email address:
Father s Name: Address: Occupation: Place of Employment: Telephone No.: Home: ( ) Cell: ( ) Work: ( ) Email address: EDUCATION Please list in the order of most recent, the educational institution(s) (secondary and tertiary) that you have attended, along with your educational qualifications for all schools listed below. Institution Examining Body Subject Grade Year
Institution Examining Body Subject Grade Year EXTRA-CURRICULAR ACTIVITIES / COMMUNITY SERVICE / OTHER. Please list any extra-curricular activities, community service acts, and any involvement with any charitable organization below.
REFERENCES. Please list the names of each of the persons providing testimonials to your application. Reference 1. Name: Occupation: Relation to Applicant: Telephone No.: Email address: Signature: Reference 2. Name: Occupation: Relation to Applicant: Telephone No.: Email address: Signature: Reference 3. Name: Occupation:
Relation to Applicant: Telephone No.: Email address: Signature: COURSE OF STUDY AND RATIONALE FOR UNDERTAKING STUDIES Name of prospective Course of Study: Rationale for undertaking studies: Please indicate on a below, your rationale for undertaking the above mentioned course of study. Your chosen area of study MUST be offered by St.Mary s University in their 2016/2017 undergraduate calendar. (www.smu.ca). Use this section to provide any information to support your application, e.g. your reason for wishing to take the course of study, why you think you will benefit from it, why you think you would benefit from the scholarship and your immediate plans after completion of your course. Please DO NOT EXCEED 500 WORDS.
DECLARATION Declaration by Applicant I, declare that the information in this application form is true and complete. I understand that the scholarship is tenable only at St. Mary s University, Halifax, Nova Scotia, Canada. If awarded the Scholarship, I will act responsibly at all times and return to Antigua and Barbuda for a minimum of 3 years to contribute to the civic, charitable and community development of the nation. I can alternatively become engaged in civic, charitable and community efforts with respect to the Antigua and Barbuda diaspora in other countries. I may engage in these activities either on a voluntary basis or as an employee of a charitable organization. _ Signature by Applicant. Date. _ Signature by Parent. Date. _ Signature by Witness. Date. *HALO HERO HUMANITARIAN AWARD: The Halo Hero Humanitarian Award, a gold service medal, will be bestowed upon the successful scholarship applicant by Lady (Sandra) Williams, President and Founder of The Halo Foundation, Inc.