Application for Tusi Scholarship
Instructions: Please type or print clearly the following information. Turn in completed application,
with all supporting documents.
I. Personal Information:
Applicant First Name:
______________________ Last name:__________________________________
Home address:
_________________________________________________________________
Home city/town/village: ______________________ Region: ___________________________________
Place of birth: ________________________________________________________________________
Year of birth:
______________________________ Gender:
male___
female ___
Contact phone number: _________________________________________________________________
E-mail: _______________________________________________________________________________
II. Academic Information:
University:
________________________________________________________________________
University location (city/town and region): ________________________________________________
Department:
________________________________________________________________________
Specialization: ________________________________________________________________________
Program:
Bachelor ___
Master’s ____
Year:
1st
2nd
Type of university:
Public ___
Tuition cost per year:
_____________________________
State Admission Exam Score:
_____________________________
GPA (for 2nd year students and up):
_____________________________
GPA at the secondary school:
_____________________________
3rd
4th
Private ___
List any award or honors (e.g., graduation from school with a medal, awards from school, regional or
national Olympiads or sport contests): ____________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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III. Personal statement (limit to one page)
1) Describe how and why you decided to pursue a university degree in the chosen field of studies:
2) Describe your career plans and how this degree will help you advance your career goals:
3) Explain why you should be awarded the scholarship and how it will be help you achieve your
educational and career plans:
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IV. Proposal for volunteering project (limit to 2 pages)
Project title:
Specific activities (provide detailed description of the activities you are planning to provide through your
project):
Target group: Describe what group of people this project is targeting, how many people may benefit
from your project, and how you are planning to locate them.
Project site: Describe where you are proposing to conduct your project; be as specific as possible and
describe the location and type of facilities (e.g., school, university, library, or neighborhood).
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Expected outcomes: Describe how participants will benefit from your project and how you are planning
to achieve these goals.
Logistic arrangements: Describe any arrangements or contacts you have already made to secure
successful implementation of the project (e.g., contacted or received an agreement from project
partners (school director, library administrator); identified necessary project materials, secured office
space for the project activities.
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V. Financial needs
Supplementary employment
Do you currently work to support your education?
___Yes
___ No
IF YES, where do you work (company and position)?
______________________________________________________________________________
______________________________________________________________________________
Is your work related to your field of studies?
___Yes
___ No
If NO, do you plan to work to support your education:
___Yes
___ No
IF YES, where do you plan to work (company and position)?
______________________________________________________________________________
______________________________________________________________________________
Background information
Do any of the following statements apply to your situation? Check all that apply:
___ raised by a single parent
___ one or both parents are unable to work due to disability or serious illness
___ lost one or both biological parents
___ both parents are unemployed
___ applicant has a disability or serious medical condition
___ refugee status
___ applicant comes from a family with 5 or more children
___ both parents do not have university education
Scholarship funds
If awarded, how are you planning to use the funds provided by this scholarship? Check all that apply:
___ tuition
___ stipend (daily expenses)
___ books and other educational materials
___ computer
___ support my family
___ other (specify______________________________________________________________________)
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VI. Required documents:
Please, attach the following items to your application:
1.
2.
3.
4.
5.
6.
A copy of the State ID
Certificate of secondary education
Results from the State Admission Exam (for newly admitted students)
A document verifying student status at the university
Academic transcripts with grades (for current university students)
Detailed Resume, Bio or Curriculum Vitae (CV) outlining organizational and leadership skills and
volunteer activities
7. Two letters of recommendation from professors or school teachers describing applicant’s academic
abilities, leadership skills, and potential for growth
8. If applicable, evidence of academic achievements (regional or national Olympiads, contests, awards,
etc);
9. If applicable, document verifying financial need (e.g., proof of loss or disability of a parent, proof of
unemployment status, or employment letter from a parent).
VII. Program Administration
How did you learn about the scholarship program? Information used for statistical purposes only.
__ Internet
__ Friend or family member
__ University or school
__ State Student Admission Commission
__ Other (specify______________________________________________________________________)
Application with all supporting documents should be submitted
electronically to info@mirvari.org by November 30th, 2010.
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