MINISTRY OF EDUCATION
UNIVERSITY OF TECHNOLOGY SCHOLARSHIP (OPEN) 2014/2015
APPLICATION FORM
A. Each candidate should complete two (2) copies of this form (in BLOCK
CAPITALS) and submit them together with supporting documents to the
Ministry of Education, Tertiary Unit, 2 National Heroes Circle, Kingston 4, NO
LATER THAN MAY 1, 201 4
Doc u m e n t s to b e su b m i t t e d :
1. Certified copy of birth certificat e or evide n c e of dat e of birth.
2. A stat e m e n t writte n by a repu t a bl e me m b e r of the com m u ni t y att e s tin g
that you hav e resid e d in Jamaica during the last thre e cons e c u tiv e years .
3. Two pas s p or t- size photo gr a p h s , sta pl e d to the form.
4. One copy of stat e m e n t of not mor e than 200 words as instruc t e d at ite m
17.
5. Valid evide n c e of acce p t a n c e / r e gi s tr a tio n at the University of Technolog y.
6. Letter of approv al from Chief Person n el Officer or his repr e s e n t a t iv e (in the
cas e of applican t s in the Civil Service).
7. Certified copies of educ a tio n al certificat e s / diplo m a s and a curre n t progr e s s
report if att e n din g University.
(Pl e a s e att a c h su p p o r t i n g do c u m e n t s to back of ap p li c a t i o n form ) .
B. Applicant s are advis e d that incom pl e t e application s will NOT be acce p t e d .
Applications should be
explicit enou g h to facilitat e a decision.
C. Detac h the refer e e form att a c h e d and sub mit to your refer e e s na m e d at
item 19.
D.
The scholars hip aw ard is valid for the acad e mi c year imm e di a t el y following
the offer of the
awar d and cann o t be deferr e d for any reas o n .
Name in full ___________________________________________________________________
(BLOCK CAPS)
SURNAME
FORE NAMES
Nationality _____________________________________________________________________
Place and Date of Birth ___________________________________________________________
Sex ____________________ Telephone _____________________________________________
Address for correspondence about this application______________________________________
______________________________________________________________________________
_
Address of Permanent Residence (if not the same as 5 )
__________________________________
_______________________________________________________ Tel ___________________
Paren t s Name (Moth er) _________________________
(Fath e r)_________________________
Addres s___________________________________Addres s___________________________
_
Teleph o n e No._____________________________ Telepho n e
No._______________________
Occup a tio n ______________________________ Occup a tio n
__________________________
9.
Education al Record.
INSTITUTION
YEAR ATTENDED
FROM
TO
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9b. If inten din g to sit an exa mi n a tio n before taking up the awar d, give particular s
and dat e when
result is exp e c t e d .
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ACADEMIC QUALIFICATIONS - STATE DETAILS CLEARLY, WHERE APPLICABLE THESE
SHOULD INCLUDE PROFESSIONAL CERTIFICATES AND DIPLOMAS OBTAINED.
DATE
EXAMINATIO
N
SUBJECTS
STATE LEVEL
(ADVANCE,
ORDINARY,
PRINCIPAL
OR
SUBSIDIARY)
RESULTS
(GRADE)
10. Acade mic Distinction s gain e d or offices held during educ a tio n al care e r..
.
11. Propos e d cours e( s )..
12. Lengt h of Propos e d Cours e..
13. Period which you exp e c t aw ard to cover..
14. Extra- curricular inter e s t s and activities, if any
15. Propos e d future occup a tio n ..
16. Have you applied to/be e n acce p t e d by the University of
Technolog y..
17. Outline in not more than 200 words why you wish to purs u e this cours e and
the ben efits to be
gain e d from the cours e.
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-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------18. Indicat e extr a- curricular inter e s t s / a c tivitie s
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
19. Pleas e give the na m e s of two refer e e s prefer a bly pers o n s und e r who m you
hav e studie d or worke d.
1.
Nam e ________________________________________________________________
Position ________________________________
Institution
__________________________
Addres s _________________________________________________Tel
_________________
2.
Nam e ________________________________________________________________
Position _______________________________ Institution
___________________________
Addres s ________________________________________________
Tel_________________
Detac h acco m p a n yi n g refer e e forms and sen d the m to the pers o n s you
hav e listed abov e.
20.
Any other inform a tio n which you consid er relev a n t to this application.
____________________________________________________________________________
____________________________________________________________________________________________
Signa t u r e ________________________________________
Date ____________________________________________
Kindly sub mit to:-
Minis tr y of Educ a t i o n
The Tertiar y Unit (Buildi n g 3)
2 Nati o n a l Hero e s Circl e
P.O. Box 49 8
King s t o n 4
Tel: 92 2 - 14 0 0 - 9
