AQuA PROGRAMME MANAGEMENT

AQuA ACHIEVER (UPPER SIXTH FORM)

Applicants who receive other official scholarships are not eligible

SCHOLARSHIP AMOUNT $45,000.00 DATE OF APPLICATION

NAME OF APPLICANT

SCHOOL

DATE OF BIRTH NATIONALITY

ADDRESS

PARENT/GUARDIAN RELATIONSHIP

TELEPHONE EMAIL

ARE YOU GETTING ASSISTANCE FROM THE PATH PROGRAMME? YES NO (this will not disqualify applicant)
A COPY OF ALL SCHOOL REPORTS AND EXAM RESULTS FOR THE PAST ACADEMIC YEAR IS REQUIRED. PLEASE SUBMIT ALONG
WITH THIS APPLICATION
HAVE YOU HAD ANY DISCIPLINARY ACTION TAKEN AGAINST YOU OVER THE PAST SCHOOL YEAR?
YES NO If “yes” explain

DESCRIBE IN DETAIL YOUR INVOLVMENT IN ANY COMMUNITY SERVICE PROJECT OR LEADERSHIP/MENTORSHIP ROLE
WHICH YOU ASSUMED OVER THE COURSE OF THE PAST ACADEMIC YEAR.

SCHOOL OFFICIAL RECOMMENDING APPLICANT POSITION

I CERTIFY THAT ALL INFORMATION IN THIS APPLICATION IS CORRECT, TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT
SERVICE AND SCHOOL RECORDS/REPORTS MAY BE VERIFIED. I ALSO UNDERSTAND THAT THE SCHOOL OFFICIAL WHO IS
RECOMMENDING ME MAY BE CONTACTED FOR FURTHER INFORMATION.

FUNDS FOR THI S SCHOLARSHI P PROVI DED BY