Application Form – EBAS Antigua Ltd.

1General Information

2Secondary Level - Academic Qualifications

3Tertiary Level - Academic Qualifications

4Course Information

5Declaration by Applicant

Name *

First

Last

Address

Address Line 1

City

State / Province / Region

Postal Code

Telephone No.

Email *

Date of Birth *

Gender *

Male
Female

Place of Birth

Which Friends of EBAS Scholarship Are You Applying For ? *

Antigua State College
UWI (Five Island Campus)

How Many CXC/CSEC Subjects Have You Taken ? *

Examining Body: CXC / CSEC (1) *

Subject (1) *

Year (1) *

Grade (1) *

Examining Body: CXC / CSEC (2) *

Subject (2) *

Year (2) *

Grade (2) *

Examining Body: CXC / CSEC (3) *

Subjects (3) *

Year (3) *

Grade (3) *

Examining Body: CXC / CSEC (4) *

Subject (4) *

Year (4) *

Grade (4) *

Examining Body: CXC / CSEC (5) *

Subject (5) *

Year (5) *

Grade (5) *

Examining Body: CXC / CSEC (6) *

Subject (6) *

Year (6) *

Grade (6) *

Examining Body: CXC / CSEC (7) *

Subject (7) *

Year (7) *

Grade (7) *

Examining Body: CXC / CSEC (8) *

Subject (8) *

Year (8) *

Grade (8) *

Examining Body: CXC / CSEC (9) *

Subject (9) *

Year (9) *

Grade (9) *

Please List Other CXC/CSEC Subjects Taken *

Separate subjects by commas.

How Many CAMBRIDGE/CAPE Subjects Have You Taken ? (copy)

EXAMINING BODY: CAMBRIDGE/ CAPE (1) *

Subject (1) *

Year (1) *

Grade (1) *

EXAMINING BODY: CAMBRIDGE/ CAPE (2) *

Subject (2) *

Year (2) *

Grade (2) *

EXAMINING BODY: CAMBRIDGE/ CAPE (3) *

Subject (3) *

Year (3) *

Grade (3) *

EXAMINING BODY: CAMBRIDGE/ CAPE (4) *

Subject (4) *

Year (4) *

Grade (4) *

EXAMINING BODY: CAMBRIDGE/ CAPE (5) *

Subject (5) *

Year (5) *

Grade (5) *

EXAMINING BODY: CAMBRIDGE/ CAPE (6) *

Subject (6) *

Year (6) *

Grade (6) *

Please List Other CAMBRIDGE/CAPE Subjects Taken *

Separate subjects by commas.

Other Certificates, Degrees & Diplomas

Extra Curricular Activity Involvement

Name & Address of University/College/Institution you are currently enrolled: *

What degree are you pursuing? *

Field of Study *

Date of Commencement of Course *

Date of Expected Completion of Course: *

Career Choice *

Accumulated GPA to date *

Cost of Study

Tuition EC$ *

Books, Supplies, Equipment EC$ *

Other Fees EC$ *

Funding

Personal EC$ *

Family EC$ *

Other Scholarship/Awards* EC$ *

Other EC$ *

*Provide brief particulars of other Scholarships/Awards include, and duration:

Transcript *

Click or drag a file to this area to upload.

Include your official transcript with this application.

Essay *

Click or drag a file to this area to upload.

Attach an essay that outlines your educational objectives, career goals, and how your course of choice and the scholarship will help you attain your goals. Please also give your reasons for choosing the course of study and how it will benefit Antigua & Barbuda.

References

Submit two (2) letters of references—at least one academic, furnished by a faculty member.

Reference No. 1 *

First

Last

Reference No. 1 Telephone

Reference No. 2 *

First

Last

Reference No. 2 Telephone

I CERTIFY that the statements made by me in this form are true, complete and correct to the best of my knowledge, information and belief.

Date

Name *

First

Last

Passport Bio Page

Click or drag a file to this area to upload.

Please Upload A Clear Image Of Your Passport Bio Page.

Signature

Clear Signature

IMPORTANT

This form does not guarantee selection for any scholarship.
Copies of academic qualifications must be included.
Copy of Valid Government Photo ID (Antiguan and Barbudan Passport preferred)

The Application Form together with all supporting documents must be submitted via email to info@ebasantigua.com and addressed;

Dr. Rosa Lee Drive,

Lower Gambles,

St. John’s, Antigua

Scholarship Application Form

Cost of Study

Funding

References

IMPORTANT

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