Prospect Connect

Application Form
This application form is for students wishing to apply to Prospect Burma’s Prospect
Connect Programme. Please provide the following documentation alongside your applica
form:

● Photocopies of High School Certificate and University Graduation

Certificate.
● Reference letters from two individuals who can write in support of your
character and academic abilities. Please also provide the contact details of
your referee in the appropriate section of the form.
● Photocopies of your Identification documents - either a passport or identity
card that you currently hold.

Prospect Connect
This is a four-months, 100-hour, intermediate/upper intermediate/advance English online
programme with students that live in multiple locations across the country. Prospect
Burma's knowledge partner, EduLink, will provide the online curriculum for this
programme.

During the course all students will also participate in various online workshops led by
Prospect Burma; this will give students an opportunity to interact with the entire cohort
and Prospect Burma team members.

Each student will take an IELTS test at the end of the course in order to determine their
score, and if additional English courses are required. Each student will have the chance to
increase their English score to 5.5 during the four-months programme.

Application Guidelines
Every section is mandatory. If you are unable to provide information, please mark “N/A” in
those specific sections.

1. YOUR PERSONAL DETAILS

Full Names
 Aliases (if any)

Date of Birth

Place of Birth

Gender

Ethnic Origin

Religion

Marital Status

Original Address

Current Address

Guardian Phone for Emergency

Contact
Personal Phone

Email

Facebook link

2. PREVIOUS EDUCATION

a. High School Information

Name of the High School

Location of the High School

Year of Exam Passed

b. University Information

Name of the University

Location of the University

Final Year Exam Result Known (Yes/No)

If yes, Final Year Passed date

If no, Expected Result Date

Start year and end year of university

(eg., from 20XX to 20XX)

If there are any year gaps between your university starting and ending years, please clarify the reason.

c. International Experience

Have you travelled to any other

countries? (Yes/No)
If yes, please provide details including
when, where and for what purposes.

3. REFEREES

Please provide the details of a referee who can vouch for your character and abilities.

a. First Referee

Name

Employer

Position

Address

Telephone

Email

b. Second Referee
 Name

Employer

Position

Address

Telephone

● Email

4. FAMILY INFORMATION

If either or both parents are retired or deceased, please give their previous occupation.

Father
Name: Occupation:
State/Region and Country of residence:

Is your Father Retired? Is your Father deceased?

(Yes/No) (Yes/No)

Mother
Name: Occupation:
State/Region and Country of residence:

Is your Mother retired? Is your Mother deceased?

(Yes/No) (Yes/No)
Have either of your parents attended university? (Yes/No)

If yes, please give details of your parents' education below (Course; Level eg. Non-formal education/ Middle School/
High School/undergraduate/postgraduate/doctoral, and Country):

Have any of your siblings attended university? (Yes/No)

If yes please give details of their education below (Name; Course; Level eg. Non-formal education/ Middle School/
High School/ undergraduate/postgraduate/doctoral, and Country):

5. SMART PHONE ACCESS

Do you have access to a smart phone? YES/NO

If YES, please let us know the regular number of hours per week you would be able to access that phone.

6. INTERNET ACCESS
Do you have wifi/fiber internet access in your place? YES/NO

If NO, please mention how you will join the online class delivered by this programme?

7. BIOGRAPHY
In an essay of 300 words or less, please give details about your background and childhood, by referencing
your education journey and any service-oriented activities in your community that you have been involved in.
Please highlight how your journey and any activities undertaken have shaped your worldview, and your
interest in furthering your education.

8. FUTURE PLANS
In an essay of 300 words or less, please tell Prospect Burma about your short-term and long-term plans,
including how you intend to contribute to your community and Myanmar’s future. Please discuss how
attending this course would affect both your short-term and longer-term plans.
9. DECLARATION

To the best of my knowledge, the information I have presented in this application is accurate. I can confirm
that I have not knowingly fabricated or falsified any information provided in this document. I understand that
if I am caught providing false information my Prospect Burma scholarship will be cancelled with immediate
effect, and I will be blacklisted from applying for future scholarships from Prospect Burma.

Signed:

Date: