LOCAL SCHOLARSHIP & GRANT

APPLICATION FORM 2021

(Tertiary level students only)

Instructions:
1. Please clearly print the required information.
2. Submit the completed application form with all supporting documents via email to ipa@rusal.com. If this application is
incomplete, inaccurate, or unsigned, it WILL NOT be considered.
3. In addition to providing the supporting documents, you are also required to submit an essay in which you tell us about
yourself, describe your career goals and tell us why you need this scholarship and how it will help you.
4. Previous recipients DO NOT need to complete the list of previous institutions attended and SHOULD NOT submit an essay.
5. WINDALCO employees and their children are ineligible for consideration.

SECTION A - PERSONAL DETAILS

APPLICANT’S NAME: _______________________________________________________________________________________

(SURNAME) (FIRST NAME) (MIDDLE INITIAL)

PRESENT ADDRESS: _______________________________________________________________________________________

_______________________________________________________________________________________

PHONE: (MOBILE) _________________________________ (HOME) _____________________________________

E-MAIL ADDRESS: _______________________________________________________________________________________

PLACE OF BIRTH: ________________________________________ DATE OF BIRTH: ______________________________

AGE: _________________ GENDER: ___________________

MOTHER’S NAME: ______________________________ FATHER’S NAME: _____________________________________

MOTHER’S EMPLOYER: ______________________________ FATHER’S EMPLOYER: _________________________________

MOTHER’S JOB TITLE: ______________________________ FATHER’S JOB TITLE: __________________________________

MOTHER’S PHONE #: ______________________________ FATHER’S PHONE #: __________________________________

MOTHER’S EMAIL: ______________________________ FATHER’S EMAIL: _____________________________________

SECTION B - SCHOLARSHIP DETAILS

Check the scholarship for which you are applying/attending:

☐University of the West Indies (UWI) ☐University of Technology (UTech) ☐Northern Caribbean University (NCU)

☐Agricultural College, Please state: _______________________ ☐Teachers’ College, Please

state:____________________

☐GC Foster College ☐Other, Please state: _________________________________________________________________

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 Check the Applicable Programme:

☐Undergraduate ☐Associate Degree ☐Diploma ☐Other, Please

state:__________________________________________

State your Major/ Area of Specialisation:_______________________________________________________________________

_________________________________________________________________________________________________________
What year are you scheduled to complete this programme: _______________________________________________________

Clearly state your ID #: _____________________________________________________________________________________

Check the level you will be at for the upcoming academic year:

☐First Year ☐Second Year ☐Third Year ☐Final Year

Have you received any financial assistance with your tuition fees for the upcoming academic year?

☐Yes ☐No
(If yes, please state source and amount below)

Source:_______________________________ Source:_______________________________

Amount(J$):___________________________ Amount (J$):___________________________

Will you be residing on campus, renting or commuting from home? Please state approximate cost for the school year.

☐Residing on campus ☐Renting ☐Commuting from home ☐Online study

Approximate cost: _________________________________________________________________________________________

Were you employed for the summer?

☐Yes (If yes, please state where, for how long and the amount earned below) ☐No (Please state why not below)

_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

SECTION C - EDUCATION DETAILS

State the last three institutions you have attended, listing your last institution first. Certified copies of your transcripts and/or
certificates must be submitted with your application.

Award Major Field of

Dates of Date Awarded
Institution and its location (certificate or Specialisation
Attendance or Expected
degree) (where applicable)
1.

2.

3.

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Have you ever received academic awards for scholastic achievement (excluding primary level for first time applicants and
secondary level for repeat applicants)?

Yes (if yes, list the 3 most recent major ones) No

1. _____________________________________________________________________________________________________
2. _____________________________________________________________________________________________________
3. _____________________________________________________________________________________________________

OTHER DETAILS

1. In no more than 600 words, tell us about yourself. Describe your career goals and tell us why you need this scholarship and how it
will help you. Your submission should be typed and double spaced with size 12 font.

2. See page 4 for the list of other supporting documents required.

TERMS AND CONDITIONS

1. Successful applicants must maintain a Grade Point Average of at least 3.0. in order to be considered for future assistance.
2. Failure to perform in accordance with the University’s Academic Standards of Progress may result in a withdrawal of the
scholarship and/or no consideration of future applications.
3. Successful applicants may be required to participate in company publicity events as advised by WINDALCO’s IPA Office. See
authorisation clause below.

AUTHORISATION INFORMATION

I release to WINDALCO and its Scholarship Committee, the right to access all my current academic records and transcripts.
If awarded a scholarship, I understand that I must meet the scholarship criteria, terms and conditions.

I understand my name and information from my academic history may be released to WINDALCO and its Scholarship
Committee. If awarded a scholarship, I release to WINDALCO and its Scholarship Committee, the right to include me in
company publicity events as advised by WINDALCO’s IPA Office. These are inclusive of, but not limited to, arranging a
meeting with the Sponsor(s) and using my name, story, and picture for printed and video materials, reports, and press
releases, as well as attending ceremonies and receptions all without compensation.
________________________________________________________________________________________________________________________

Your completed application and supporting documents must be received by WINDALCO’s Information & Public Affairs Department by
4:00 p.m. on Friday, August 13, 2021.

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I certify that the statements herein are true to the best of my knowledge and grant my permission for the information contained herein
to be shared with WINDALCO’s Scholarship Committee. I further certify that if, for any reason subsequent to receiving a scholarship, I
elect to substantially alter my proposed study plan, I will immediately inform the Scholarship Committee.

APPLICANT’S SIGNATURE: _________________________________________________ DATE:___________________________

PARENT’S SIGNATURE: __________________________________________________ DATE:___________________________

FOR COMPANY USE ONLY

DOCUMENTS REQUIRED
FIRST TIME APPLICANT REPEAT APPLICANT

Completed application form Completed application form

Completed essay Schedule for fee payments or letter from
Letter of acceptance from institution if entering same for the institution outlining tuition costs
the first time (must be on school’s letterhead) (must be on school’s letterhead)
Schedule for fee payments or letter from the institution Statement of payment/account balance
outlining tuition costs (must be on school’s letterhead) from institution
Statement of payment/account balance from institution Academic report/professional certificates
One certified passport-sized photograph and/or transcripts*
One certified photocopy of a valid national identification (National * Unofficial transcripts WILL NOT be
Registration ID, Passport or Driver’s Licence) accepted.

Official academic report/professional certificates and/or transcripts*

Birth certificate
School leaving certificate (if entering first year)
* Unofficial transcripts WILL NOT be accepted.

Note: Copies of original documents and certificates MUST be certified by a Justice of the Peace and scanned along with the
application form to ipa@rusal.com.

RECEIVED BY: ___________________________________________ DATE: _____________________________

NAME: ____________________________________________ LOCATION: ___________________________

COMMENTS:
____________________________________________________
____________________________________________________
____________________________________________________
COMPANY STAMP
____________________________________________________
____________________________________________________

IPA Department: July 2020 4|P a ge