THE UNIVERSITY OF THE WEST INDIES
OPEN CAMPUS
REGISTRY OF STUDENT SERVICES
APPLICATION FOR FINANCIAL ASSISTANCE
INSTRUCTION SHEET
▪
Please read the instructions carefully before completing this form and answer all relevant questions.
Incomplete applications will not be processed.
▪
Completed application forms should be submitted to the Open Campus, Registry of Student Services by
email - scholarship.applications@open.uwi.edu by August 31, 2015
▪
Please indicate ‘N/A’ where the information requested in an item is not applicable to your situation.
▪
Where income figures are required, gross amounts must be stated in UNITED STATES DOLLAR amounts
▪
All applicants must complete the entire application for it to be considered, providing all additional
documentation as stated. This is mandatory.
▪
Please be detailed in your self expression of NEED as this is a strong factor in consideration for
this award. Short explanations are discouraged.
▪
Letters of recommendation must be submitted with all application forms. Kindly note the following
persons from whom references may be obtained:
- Members of Open Campus Management team
- Site Heads
- Justices of the Peace
- Ministers of Religion
 Award
Western Union Pride of the Caribbean Scholarships 2015-2016
Award is based on Academic Merit and Performance and demonstrated financial need.
Applicants must:
 Be Caribbean nationals, Caribbean born, or of Caribbean parentage(a US-born child of at least one
Caribbean-born parent).
 Currently be residing in the Caribbean.
 Be 18 years or older.
 Be entering level two of their Bachelor degree programme.
 Have a Cumulative and Degree GPA of 3.0 or higher.
 Graduate Students must have obtained at least an Upper Second Class Honours degree at the
undergraduate level.
 Demonstrate great financial need.
 Be involved in some kind of community/voluntary service, e.g. Youth Clubs, Service Clubs etc.
 Meet all other requirements of the UWI pertinent to student behavior and performance
THE UNIVERSITY OF THE WEST INDIES
OPEN CAMPUS
REGISTRY OF STUDENT SERVICES
APPLICATION FOR FINANCIAL ASSISTANCE
AWARD
Student UWI ID # :
NAME
Title
Last Name
First Name
Middle Name(s)
Western Union Pride of the Caribbean Scholarships 2015-2016
Deadline
August 31, 2015
Number of Awards
Seven (7)
Value
US $5,000 (2 scholarships)
US $1,000 (5 scholarships)
Maximum Tenure
One (1) year
APPLICATION CHECKLIST:

Completed and signed Award application

2 Letters of Recommendation

Proof of financial status (to include Payslips, etc.)

Resume/Curriculum Vitae
1
THE UNIVERSITY OF THE WEST INDIES
OPEN CAMPUS
REGISTRY OF STUDENT SERVICES
APPLICATION FOR FINANCIAL ASSISTANCE
BIOGRAPHIC PROFILE
1. UWI ID #
2. Former UWI ID # (if applicable)
3. NAME
Title
Last Name/Surname
First Name
Middle Name(s)
4. Former
NAME
(If
Applicable)
Title
Last Name/Surname
First Name
Middle Name(s)
5. Name Type of Former Name: Maiden [ ]
___________________________
6. Date of Birth
dd/ mm
(Prior to) Deed Poll [ ]
/ yyyy
7. Sex: Male [ ]
Female [ ]
9. Country of Birth
Please Specify
8. Marital Status
10. Nationality
11. Are you a UWI Staff Member?
13. Disability
]
Other [ ]
Yes [ ]
No [
Yes [ ]
No [ ]
12. Are you a dependent of a UWI Staff Member?
Yes [ ] No [ ]
14. Employment Status
15. Employer
16. Employer’s Address
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
17. Employer’s
Telephone _________________________________
18. Employer’s
E-mail Address ____________________________________
CONTACT INFORMATION
19. Permanent Address
22. Term/Mailing Address (if different)
Apt./Street/P.O. Box______________________________
Apt./Street/P.O. Box _________________________________
___________________________________________________
_____________________________________________________
___________________________________________________
City/Town
20. Home Phone
Parish
Country
21. Cellular Phone
_____________________________________________________
City/Town
23. Other Phone
Parish
Country
24. E-mail Address
2
ACADEMIC PROFILE
25. Year of First
Admission
29. Enrolment
Status
26. Site
30. Level
27. Programme (BA, BSc,
MA, MSc etc.)
31. Country of Responsibility
28. State your Major/Option
32. Expected Date of Graduation
BLANK SPACE
33. Campus
BLANK SPACE
PARENTAL INFORMATION
34. Mother or Stepmother (if responsible for you)
35. Father or Stepfather (if responsible for you)
Name
Name
Address__________________________________________
Address__________________________________________
___________________________________________________
__________________________________________________
___________________________________________________
__________________________________________________
Telephone (W)
Telephone (W)
Telephone (H)
Telephone (H)
Occupation
Occupation
Employer
Employer
Salary $_____________________
Salary $_____________________
Weekly - [ ] Fortnightly - [ ]
Weekly - [ ]
Monthly - [ ] Annually - [ ]
SPOUSAL INFORMATION
Fortnightly - [ ]
Monthly - [ ] Annually - [ ]
DEPENDENT CHILDREN
36. Name
37. Name
Address (If Different from Applicant’s Permanent Address)
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
Name of Child’s School
38. Name
Age
Age
Name of Child’s School
39. Name
E-mail Address
Name of Child’s School
Telephone (H)
40. Other Dependent Children? Yes [ ]
65. Age
No [ ]
Telephone (W)
Occupation
Employer
Salary $_____________________
Weekly - [ ]
[ ]
Fortnightly - [ ]
Monthly - [ ]
Annually -
3
BUDGET PLANNER
41. Budget for Academic Year ________/________
Expenses (USD$ only)
Income/Resources (USD$ only)
Tuition Fees
________________________
Present Bank Balance
__________________
Books and Supplies
________________________
Spouse’s Contribution
__________________
Family Contribution
__________________
Accommodation
Off Campus
________________________
Contribution From Other Sources
__________________
Proceeds From Employment
__________________
Food
________________________
Awards (e.g. Scholarships, Bursaries)
Clothing
________________________
Name of Award
Toiletries
________________________
Transportation
To and From the UWI
________________________
Practicum/field trips
________________________
Contingencies (Please Specify)
Item
Cost ($)
a. ______________________
______________________
b. ______________________
______________________
c. ______________________
______________________
d. ______________________
______________________
Total Expenses
===================
a.
_______________________________
b.
_______________________________
Value
($) ______________
($) ______________
c. _______________________________
($) ______________
Tuition Loans (e.g. SLB etc.)
Value
a.
_______________________________
b.
_______________________________
($) ______________
($) ______________
Grants
a.
_______________________________
b.
_______________________________
Other Income/Resources
__________________
($) ______________
($) ______________
Total Income/Resources
================
Shortfall (Subtract Total Expenses from Total
Income)
42. I affirm that the information provided within this form is correct:
___________________________
Applicant’s Signature
________________________
Date (yyyy/mm/dd)
4
43. Do you wish to be considered for scholarships and bursaries?
Yes [ ]
No [ ]
44. Will you apply for transfer to another Faculty/Campus in the upcoming academic year? Yes [ ]
No [ ]
45. If yes to Ques. 44 state
45a. Faculty
45b. Campus
name of:
46. Have you been awarded a Scholarship/Bursary tenable at UWI Yes [ ] No [ ]
If Yes, state name of Award ___________________________________________________ Value $____________________
47. Declaration of Financial Need
_________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
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5
48. Work Experience
Indicate jobs held within last five years (including vacation employment)
Name of Organisation
Position Held
From
To
yyyy
yyyy
yyyy
yyyy
/
/
/
/
mm
mm
mm
mm
/
/
/
/
dd
dd
dd
dd
yyyy
yyyy
yyyy
yyyy
/
/
/
/
mm
mm
mm
mm
/
/
/
/
Salary
/month
dd
dd
dd
dd
49. Career Objective
State your career goals, and the contribution you think you will be able to make towards the
development of your country:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
50. Academic distinctions and/or prizes received:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
51. State benefits to be gained from your successful training:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
52. State reason(s) for applying which may include, but not restricted, to financial circumstances:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
53. PREVIOUS ASSISTANCE RECEIVED FROM THIS OFFICE (IF APPLICABLE)
DONOR
YEAR
AMOUNT ($)
6