sbm scholarship scheme 2013 application form

7/27/2019 SBM Scholarship Scheme 2013 Application Form

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SBM Scholarship Scheme 2013 - Application Form 1

THE SBM EDUCATION FUNDACADEMIC YEAR 2013/2014

Application form for Undergraduate Scholarships

The completed Application Form should be submitted by registered post or hand-delivered to theThe Trustees, The SBM Education Fund, c/o DTOS Trustees Ltd, 10 th Floor, Raffles Tower,

19 Cybercity, Ebene by Friday 30 August 2013.

Please fill in block letters:

1. Personal details of applicant:

a) Last Name of applicant (Mr/Mrs/Miss)

b) First name of applicant: ...

c) Maiden name (if applicable)

d) Marital Status : Single Married Other

e) National Identity Number : ..

f) Date of birth : ..

g) Nationality :

If naturalised, certificate of naturalisation to be annexed

h) Residential Address

..

..

..

i) Telephone number: Residence ..

Office ..

Mobile ..

j) E-mail address : ..

k) Situation of parents / family:

Married Divorced Widow Single parent Other


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l) Details of Siblings

Name Relationship M/F DOB Age Occupation

m) Do you perceive a Basic Invalidity Pension from the Ministry of Social Security? _________

2. Scholarship applied for:

Certificate Diploma Higher Diploma Degree

3. (a) Programme of Study (e.g B.A. (Hons) English, BSc. (Hons) Maths)

(b) Duration of programme of study

..

(c ) Starting date: .

(d) Fees applicable:

Tuition Fees

Examination Fees

Library Fees

Student Union Fees

Other Administrative Fees

TOTAL (Rs)

4. University/Higher Education Institution name and address:

.

.

.


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5. Education qualifications :

School Certificate Results

Cambridge School Certificate G.C.E. O, Level Other Qualifications(Cambridge/London) (Second, etc)

Year : . Year : . Year : .

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

. . .. ..

Overall Aggregate : ..


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Cambridge Higher School Certificate Results

Year : Year :

Rank : Rank : .

Side : Science / Economics / Technical / Arts / Other (specify )

Subjects Subject Grade Subjects Subject Grade

Principal Level :-

..

..

..

..

Principal Level :-

..

..

..

..

Subsidiary Level : -

General Paper

..

..

..

.

.

.

Subsidiary Level : -

General Paper

..

..

..

.


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General Certificate of Education A Level

(University of London/Cambridge)

Month :

Year :

Month:

Year :

Subject Grade Subject Grade

Other Secondary Education Qualifications (please specify)

(e.g Baccalaureate, etc)

Name of Institution: . Year : .

Subjects Levels Grade


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University qualifications and other Relevant Qualifications (Academic/Professional/Technical)

Qualification obtained

(in case of degree, state whether

Hons/Special/Ordinary/General)

Class/Division/

Mention

Subject Examining

Body

Date

Yea

Have you been previously nominated for a scholarship? YES / NO

IfYES give details as follows:

Country Scheme Year Course of

study

Offer

accepted

Successful Offer no

accepte

why?

1.

2.

Name, Address and Occupation of 2Referees:

Name Address Occupation Tel No.

(Testimonials should accompany application form with full contact details to enable us tocontact the Referees)


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6. Family Income

Fathers occupation

Name of employer

Address of employer

Contact Details

Fathers wages/salary Rs

Mother Occupation .

Name of employer

Address of employer

Contact Details

Mothers wages/salary Rs

Monthly Income of Student (if applicable) Rs

Other Income (Pension, Social Aid, etc) if any Rs..

Total Family Income Rs .

(Recent payslips and other evidences to be attached)

7. Total amount of Scholarship applied for per annum: Rs

(The amount of the Scholarship would be determined upon final selection of course and will be

subject to a maximum of Rs 30,000 per annum for students from Mauritius).

8. Are you benefiting from any other Scholarship/Sponsorship/Financial Assistance

for the course/s for which application for scholarship is hereby being made. (Please

tick as appropriate)

Yes No

If Yes please provide the following details:

(i) Amount of Scholarship/Sponsorship/Financial Assistance received: Rs

(ii) Name of Organisation/Institution providing the Scholarship/Sponsorship/ Financial

Assistance

(iii) Contact person from the organization/Institution at (ii) above:

Name :. Phone No : ...............................


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9. Declaration

I declare that, to the best of my knowledge and belief, the particulars given on this form are true

and correct and that no information which might affect the decision of The SBM Education Fund

has been withheld. I hereby agree to abide by the conditions attached to the Scholarship offered

by The SBM Education Fund.

Signature: ..

Name :..

Date :..

10. Documents to be submitted

Application form duly filled in

Letter of motivation

Copy of birth certificate of applicant and his/her parents and their marriage certificate

Certified copies of results of SC/ O level and HSC/ International Baccalaureate orequivalent, and any other relevant qualifications held.

Copy of letter of offer/Evidence of enrolment specifying nature of course and coursetitle / Evidence of having secured a seat in a recognized higher education institution

in Mauritius

Testimonials from two referees, who know the candidate personally. At least one ofthe referees must be familiar with the academic record of the candidate.

Evidence that his/her family household income does not exceed Rs 15,000 per month

Proof of address (copy of a recent utility bill, less that 3 months old)

Evidence from the Ministry of Social Security or the National Council for theRehabilitation of the Disabled (NCRD) that applicant benefits from a Basic Invalidity

Pension (if applicable)