UWI Five Islands Scholarship Application Form

The Application Form together with all supporting documents must be submitted in a sealed enveloped marked Personal & Confidential and addressed to:

Rotary Club of Antigua UWI Scholarship

Rotary House

Corner Sir Sydney Walling Highway & Nugent Avenue

St. John’s, Antigua

Attn: UWI Scholarship Committee

UWI Scholarship Application Form

PERSONAL DETAILS

Last Name:

First Name:

Other Name(s):

Residential Address:

Mailing Address:

Telephone No.:

E-mail:

Date of Birth (dd/mm/yyyy):

Place of Birth:

Gender: Male Female

Emergency Contact Details

Contact Full Name:

Relationship:

Address:

Telephone No.:

ACADEMIC QUALIFICATIONS












List college and secondary school activities (student government, sports, publications, school-sponsored community service programs, student-faculty committees, arts, music, etc.). List in descending order of significance. You will have space for eight college and four high school activities.
College Activities
Name of Activity	Date	Office








Secondary School Activities
Name of Activity	Date		Office






List public service and community activities (social services, environmental protection/conservation, advocacy activities, work with religious organizations, etc.). Do not repeat items listed previously. List in descending order of significance.
Name of Activity	Roll		Date







List part-time and full-time jobs since secondary school/college graduation.
Type of Work	Employer and Address		Phone	Date






List awards, scholarships, publications or special recognitions you have received. List in descending order of significance.






Describe one specific example of your leadership. (The writer of your letter of recommendation re: Leadership Abilities and Potential must confirm this experience.)




Describe a recent particularly satisfying public service activity (do not repeat experience described in 6). (The writer of


Describe the problem or needs of society you want to address when you enter public service. (If possible, use statistical data to define the magnitude of the problem.)


What are the three most significant courses you have taken in preparation for your career?

TRANSCRIPTS

Certified copies of your official transcript are to be submitted with this application.

ESSAY

Attach two copies of an essay (typed with double line spacing) that outlines your educational objectives, career goals, and how your course of study and this scholarship will help you to attain your goals. Please include your reasons for choosing the course of study and how it will benefit Antigua and Barbuda.

REFERENCES

Please submit two (2) letters of references; one academic letter is required.

DECLARATION BY APPLICANT

I CERTIFY that the statements made by me in this form are true, complete and correct to the best of my knowledge, information and belief. If awarded the scholarship, I am willing to sign a Band agreement to work for at least one (1) year and to seek permission form the Rotary Club of Antigua prior to any change in my present course of study.

DATE(dd/mm/yyyy):

PRINT NAME: ________________________________

SIGNATURE: _______________________________

IMPORTANT