BROWARD VIETNAM

MERIT SCHOLARSHIP APPLICATION FORM

Full Name: ........................................................................................................................................

Date of Birth (DD/MM/YYYY): ......................................................................................................

Identification Card/ Passport number: ..............................................................................................

Email: ................................................................................................................................................

Phone Number: .................................................................................................................................

Contact Address: ...............................................................................................................................

GPA of Grade 12th: ..........................................................................................................................

English GPA of Grade 12th: .............................................................................................................

I am applying for a scholarship to pursue an AS Program at Broward Vietnam. Area of Study

(Major): ............................................................................................................................................

01. Please list all student clubs and any other extracurricular activities you participate in. (If you
need more space, add a separate sheet).
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
02. Please list any additional information you wish to be considered in your scholarship
application. (If you need more space, add a separate sheet).
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................

- I certify that all information given in this application is complete and accurate. I further
understand that my failure to provide a complete and proper scholarship application package,
false information or misrepresentation of facts on this application can result in cancellation of
scholarship application and awarding.
- I affirm that all content on the Scholarship Essay is written by me and is not copied/ plagiarized
from any sources.
- I agree to abide by the decision of Broward Vietnam in the awarding and the terms of my
scholarship.

Student’s Signature

Date: ____________________________________