Application Form

Applicant’s Name: _________________________

APPLICATION FORM FOR 2014 SCHOLARSHIPS
As the language of instruction at the schools offering scholarships is English, the form should
normally be completed in English. If you are short-listed you will be invited to attend an
interview, which will also be in English
Applicants must complete Sections A to C and their parents/guardians should complete
Section D. They must then pass the form to their School Principal to complete Section E.
If you would like to discuss this application form with somebody who has previously been
awarded a scholarship, please phone Dencio (77908209), Flora (77456006), Milca (77305085) or
Octavio (78105973).
SECTION A - to be completed by the applicant (Please use BLOCK LETTERS)
1.

Full Name
Family Name ____________________________ Personal Names _________________________________________
Any Other Names by which you wish to be known

____________________________________________________

2.

Gender: ______________

3.

Date of Birth: Day __________ Month ___________ Year ________________

4.

Nationality ______________________________________ Country of Birth ____________________________________

5.

Home Language __________________________________
Other Languages ____________________________________________________________________________________

6.

Home Address

__________________________________________________________________________________

__________________________________________________________________________________________________
E-mail: _________________________________________
Mobile No. _____________________________________
(It would be useful for you to have one!)
(It is vital you enter a mobile number we can contact you on!)
7.

School ____________________________________________________________________________________________
Completion of secondary schooling

8.

Month _________

Year _______

Do you have any siblings or members of your family who are, or have been, involved with UWC? If so, give details.
__________________________________________________________________________________________________

SECTION B - to be completed by the applicant
1.

Which of the subjects you are studying at school this year do you enjoy the most and least? Explain why.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

2.

Have you decided on a future career? If so, what is it and why does it attract you?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

Applicant’s Name: _________________________
3.

Do you have any strong sports, musical or artistic interests? If so give details.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

4.

Do you spend any time helping others in your community? If so give details..
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

5.

List any other activities in your school that you are involved in.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

6.

List any activities outside of school that you are involved in.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

7.

List any other achievements or special interests you would like the Selection Committee to know about.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

SECTION C - to be completed by the applicant
1.

Write three words that describe your character.
______________________________________________________________________________________________________

2.

Describe how you spend your time when you are not at school.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

3

Which public figure, living or dead, do you regard as a good role model? Explain how you have changed your life under their
influence.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Applicant’s Name: _________________________
4

Describe briefly your family circumstances. What do your parents do? How many brothers and sisters do you have? Are they
older or younger than you? What do the older ones do? Apart from your parents, brothers and sisters, does anybody else live
with your family?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

5.

What do you think are the characteristics of Timor-Leste and its people? How would you try to represent these at a UWC?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

6.

What do you think are the major challenges for Timor-Leste? How do you think you can contribute to its development?
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

Declaration
I hereby confirm that the information given on this application form is, to the best of my knowledge, correct. I also agree to this form
being copied to members of the Blair Forster Memorial Trust, and to senior staff at schools offering scholarships through the Trust,
for the purpose of assessing my application.
Signature ______________________________________

Date ________________________________

Applicant’s Name: _________________________
SECTION D - to be completed by the applicant's Parent(s), or Guardian, as appropriate
1.

Full Name of Father _________________________________________________________________________
Full Name of Mother ________________________________________________________________________
[Full name of Guardian _______________________________________________________________________]

2.

Address ______________________________________________________________________________________________
_____________________________________________________________________________________________________

3.

Contact telephone number(s) for parent(s)/guardian:
Father _____________________________________

Mother ___________________________________________

[Guardian ___________________________________]
4.

Please indicate the state of your son's/daughter's/ward's physical and mental health. You may enclose a medical statement from
your doctor if you wish. Please note that schools will accept applications from candidates who have known handicaps over
which they have control and which will not deteriorate significantly while they are there. The school would however reserve
the right to ask an admitted student to leave if there is failure to disclose a chronic medical or mental condition.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

5.

Is there anything of special note that you would like to bring to the attention of the Selection Committee?
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

6.

I have read the application for a scholarship organised through the Blair Forster Memorial Trust made by my son/daughter/ward
and to the best of my knowledge the answers given are correct. We have discussed all aspects of the commitment involved and
this application has my full approval. Should the application be successful, I hereby undertake for myself and for him/her to
observe the rules and regulations of the school offering the scholarship. While my son/daughter/ward is in residence at that
school, I wish and authorise the school to act as Guardian in my place for decisions involving his or her personal care and
welfare.

Signature of Parent/Guardian _______________________________________ Date _________________________________
Relationship to Applicant ________________________________________________________________________________

Applicant’s Name: _________________________

TO THE PRINCIPAL
Could you please fill out this form personally or delegate this to a senior member of staff. Who may know the student better As your
opinion of the candidate is a major factor in our decision making, we really value your input. If you are unable to do this, please
return the form blank rather than asking the candidate to fill it out on their own.
The completed application form (Sections A to E) should be returned by the Principal together with certified copies of academic
record/school report/transcript of the applicant for the last two academic years to the Ministry of Education within one month of
being submitted by the student.

CONFIDENTIAL STATEMENT
SECTION E - to be completed by the School Principal
Part I - ACADEMIC ABILITY
Please enter a tick (ü) in the appropriate boxes to indicate the ability of the applicant in the subjects studied:Timor-Leste
Grade

Excellent
A
10-9

Good
B
7-8

Satisfactory
C
6

Mediocre
D
4-5

Very Weak
E
3 and below

Subject
English Language
Portuguese
Mathematics
Science
Biology
Chemistry
Physics
Economics
Geography
History
Religious Studies
*

* Please add in other subjects not listed in the table.
Part II - PERSONALITY AND CHARACTER
Please rate the applicant on the grid below by entering a tick (ü) in the appropriate boxes, bearing in mind that a grading of
outstanding indicates a quite exceptional person in this respect when compared with his/her peers:Below
Average
Willingness to work with others
Openness of personality
Concern for others
Creativity & originality
Enthusiasm & energy
Maturity and balance
Determination & self-discipline
Responsibility & leadership potential

Average

Good

Excellent

Outstanding

Applicant’s Name: _________________________
Part III - INVOLVEMENT IN EXTRACURRICULAR ACTIVITIES
If your school does not have an extracurricular programme please tick (ü) this box and go on to the next question.
If your school does have an extracurricular programme, please list the activities that the applicant has been involved in.
School year

Nature of activities

2011

2012

Part IV - GENERAL ASSESSMENT
Describe how the applicant has contributed to the life of the school and the local community over the last two years
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Please give your brief personal assessment of the applicant's personality and potential and why this makes the candidate particularly
suitable to take up a scholarship offer at an overseas school. (Alternatively you may attach a personal reference. The reference may
be written by another member of staff.)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

Signature of Principal: ____________________________________________

Date: ____________________________________

Name (in block letters): ________________________________________________________________________
School: _____________________________________________________________________________________
School Address _____________________________________________________________________________________________
__________________________________________________________________________________________________________
e-mail: _____________________________________________

Phone. No.: _____________________________

The applicant has attended this school from ___________ (year) to ____________ (year)
*** Thank you very much for supporting this application. ***

School stamp
here please