SCHOLARSHIP APPLICATION FORM
PHOTOS
2 recent passport size photos
INSTRUCTIONS:
1. Please read the form carefully and complete the relevant sections;
2. Do not write in the shaded areas.
3. This form should be submitted with:
A non-refundable fee of $300.00
Two (2) Passport Size Photographs,
*Certificates: CXC / GCE, Diploma or Associate Degree (transcripts applicable for tertiary certification)
*Birth Certificate
*Marriage Certificate (if applicable),
An Essay: Why should you be accepted for this programme and how will you use it to your benefit and the wider society
Two (2) Referee Reports
*copies along with originals should be submitted for verification
[FOR OFFICE USE ONLY]
Id number:
___________________________
PERSONAL DETAILS:
Name: ___________________________________________________________________________
Surname
Christian
Middle
Maiden Name: (where applicable) _______________________________________________
Sex: ☐ Male
☐ Female
Name to be used for official records: _______________________________________________________________________________
Permanent Address: (Home) _______________________________________________________________________________________
___________________________________________________________________________________________________________________
Mailing Address: (if different from above) ________________________________________________________________________________
___________________________________________________________________________________________________________________
E-mail address: __________________________________________________________________________________________________
Telephone: (Home) ___________________________ (Work) ___________________________ (Mobile) _________________________
Present Occupation: ______________________________________________________________________________________________
Place of Employment (Name & Address): __________________________________________________________________________
___________________________________________________________________________________________________________________
Date of Birth: ______/_________/_________
Year
Month
Day
Marital Status:
(Please Tick)
☐
Single
☐
☐
Married
Divorced
☐
Widowed
Nationality: ________________________________________
Religious Denomination: ____________________________________
Next of Kin: _______________________________________
Relationship: ________________________________[In case of emergency]
Contact # (Kin): Home) _____________________ (Work) _____________________ (Mobile) ________________________________
[FOR OFFICIAL USE ONLY]
PAYMENT INFORMATION
Receipt no.:_________________________
Amount ($): _________________________________
Date Received: _______________________
Signature: ___________________________________
PROGRAMME INFO:
First option: Please tick ( )
Bachelor of Arts in Theology
Bachelor of Science in Hospitality Management
Bachelor of Arts in Guidance and Counselling
Bachelor of Science in Nursing
Bachelor of Education (Primary)
Associate in Business Administration
Bachelor of Education (Early Childhood Education)
Associate in Programme and Project Management
Bachelor of Arts in General Studies
Associate in Business Administration with Programme and
Bachelor of Arts in Community Development
Project Management
Associate in Business Administration with Management and
Bachelor of Arts in Psychology
Bachelor of Arts in Media & Communication Arts
Information Systems
Bachelor of Science in Human Resource Management
Diploma in Early childhood Education
Bachelor of Science in Business Administration
Diploma in Theology
Bachelor of Science in Programme and Project Management
Diploma in Early Childhood Education
Bachelor of Science in Business Administration with
Certificate in Theology
Certificate in Lay Pastors and Leaders Training
Programme and Project Management
Second Option: (Please indicate your second option on the line below)
___________________________________________________________________________
Location of Study:
SURREY:
CORNWALL:
NORTH MIDDLESEX:
SOUTH MIDDLESEX:
CAYMAN:
Central (Kingston)
Portmore
Oberlin
Montego Bay
Savanna-La-Mar
Trelawny
Sandy Bay
.Browns Town
Tower Isle Campus
Tacky
Whitehall
Mandeville
Santa Cruz
May Pen
Kellits
Old Harbour
Grand Cayman
PORT ANTONIO
Snow Hill Campus
MODE OF STUDY:
☐Part time
☐Full Time
APPLYING AS A:
☐Tertiary Track Scholarship
☐First Steps Scholarship
DO YOU HAVE ANY DISABILITIES:
☐ YES
☐ NO
If yes please specify_____________________________________________________________________________________
(Please provide documentation as to the type and degree of disability)
HOW DID YOU OBTAIN INFORMATION ABOUT IUC (CLTD/MNC)? (Tick all that apply)
☐ College Fair / Expo
☐ School Visit
☐Media
☐ Website
Please indicate the name of the referee for the following categories:
Employer _________________________________________________________________________________________________________
IUC Alumnae _____________________________________________________________________________________________________
IUC Student ______________________________________________________________________________________________________
IUC Staff _________________________________________________________________________________________________________
Other ____________________________________________________________________________________________________________
FOR IDENTIFICATION CARD PURPOSE
Instructions: Kindly sign in the box provided below. Please avoid touching the borders when signing.
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Updated June 2011 / nf
EDUCATIONAL BACKGROUND:
INSTITUTION
CERTIFICATION
DURATION (SPECIFY YEARS)
Other training received: ____________________________________________________________________________________________
____________________________________________________________________________________________________________________
WORK EXPERIENCE: (List most recent first)
EMPLOYER
POSITION
DURATION (SPECIFY YEARS)
Voluntary/informal work experience:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
PERSONAL EXPERIENCE
Please indicate any other information about yourself which might help us to know you better (hobbies, family background, other interests or experiences, etc.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
RELEASE FORM
I, _________________________________ hereby give permission to the International University of the Caribbean (IUC) [Mel
Nathan College or the College for Leadership and Theological Development (formerly Institute for Theological and
Leadership Development)] to use or display my photograph, if desired, in University publications or in any advertisement of the University and its courses.
______________________________________ (Signature)
______________________________________ (Date)
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Updated June 2011 / nf
REFERENCE INFORMATION**
(Please give the names of two persons – one of whom should be your present Supervisor/Employer –who can provide information about you.)
1.
Name of Referee:________________________________________________________________________________________________
Position/Title: ____________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________
Telephone: (Home) ________________________ Office: _____________________
2.
Cell #: ________________________________
Name of Referee: _______________________________________________________________________________________________
Position/Title: ____________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________
Telephone: (Home) ________________________ Office: _____________________
Cell #: ________________________________
**Referee forms are available online or in office
[FOR OFFICE USE ONLY]
Application Received: __________________________________ (Date)
Photographs
Certificates
Transcripts
Statement of Purpose
Birth Cert.
Marriage
Cert.
Referees’
Reports
Documents
Received:
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Documents
Pending:
☐
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Checked by:
__________________________________________
IUC representative
☐ ADMIT _______________________________________
☐ 48 credits ☐60 credits
Date of Entry: _________________________________________________
☐66 credits ☐75 credits
☐90 credits
☐123 credits
☐135 credits
☐
ADMIT WITH RECOMMENDATION _______________________________________________________________________________
☐
NOT ADMITTED ________________________________________________________________________________________________
Authorized by:_________________________________________________
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Date: ___________________________________________
Updated June 2011 / nf