SCHOLARSHIP
APPLICATION FOR THE ACADEMIC YEAR 2006/2007
STUDENT
IDENTIFICATION (PLEASE
PRINT CLEARLY)
LAST NAME: ___________________________________
FIRST NAME: __________________________________
DATE OF BIRTH:______ Day: ______ Month: ______ Year:
HOME ADDRESS:
Number:__________
Street: ___________________________________
Apartment: ________________________________
CITY:_____________________________________
PROVINCE:_________________________________ CODE: _______
MAILING ADDRESS: __________________________________
___________________________________________________
TELEPHONE:________________________ CELL NO.: _____________________
FAX NO:___________________________ E-MAIL: _______________________
EDUCATION:
INSTITUTION AND AREA OF STUDY IN WHICH APPLICANT IS REGISTERED.
__________________________________________________________
STUDENT NUMBER: _________________________________________
NAME OF PROGRAMME: ______________________________________
NAME OF INSTITUTION: ______________________________________
ADDRESS OF INSTITUTION: __________________________________
__________________________________________________________
LIST HIGH SCHOOL, COLLEGES AND UNIVERSITIES YOU HAVE ATTENDED.
Name of institute: From(dates) To Grades Completed/Diploma
__________________________________________________________
__________________________________________________________
__________________________________________________________
DECLARATION
TITLE AND NAME OF SUPERVISING STAFF (PLEASE PRINT CLEARLY)
_________________________________________________
DEPARTMENT
OF SUPERVISING STAFF:
__________________________________________________________
TELEPHONE:(AREA CODE): HOME:___________________ OFFICE: ___________________
E-MAIL ADDRESS:____________________________ FAX NUMBER: ___________________
I recommend this student for this SAWW scholarship because
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
DECLARATION OF SUPERVISING STAFF:
I confirm that this applicant is currently registered for the above
program at the institution indicated, and the information provided
herein is accurate. I agree to supervise this applicant for the duration
of the scholarship.
SIGNATURE:________________________________ DATE: ___________________
DECLARATION OF APPLICANT:
I confirm that if successful in this application, I will make every
effort to attain the highest standard that I can. I also confirm
that the information provided is accurate and represents my current
situation
for the 2004 academic year. I agree to supply SAWW with copies of
transcripts as required. I grant SAWW permission to use any information
I send
at their discretion.
SIGNATURE:_______________________________DATE: ___________________