Scholarship Application Form
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Nuwemuramuzi Ian MartinScholarship Application Form
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INTER-UNIVERSITY COUNCIL FOR EAST
AFRICA
P.O. BOX 7110 KAMPALA
THE EAST AFRICAN COMMUNITY STUDENTS’ MOBILITY SCHOLARSHIP SCHEME
(EAC-SMS)
SCHOLARSHIP APPLICATION FORM
To be eligible for this scholarship, applicants must satisfy the following requirements:
a) Citizenship: Be a national and resident of a partner state of the East African
Community;
b) Eligible programme at an eligible university: Have been accepted for admission in
an eligible programme at an eligible university that participates in the
EAC-SMS and is in another country of the EAC other than their own.
However, applicants should not wait until they are admitted to apply
for the scholarship.
c) Statement of motivation: Submit a motivation letter in English (with not more than
300 words) as follows:
Well written (grammatically and professionally)
Demonstrate a convincing motivation for wanting to pursue the
Programme chosen
Adequately demonstrate the foreseen professional engagement
in EAC Integration agenda after completing the Programme
Demonstrate how the acquired skills and knowledge from the
Programme will be applied to contribute to the EAC Integration
Agenda
Demonstrate where they anticipate seeing themselves
professionally and academically in 5 and 10 years.
d) Financial need: Demonstrate financial need;
e) Age, academic performance record & experience:
Undergraduate Masters PhD
e) Be below 22 years e) Be below 35 years of e) Be below 45 years of age
of age at the time of age at the time of at the time of application.
application. application.
f) Excellent academic
f) Excellent academic f) Possess at least an performance record.
performance record equivalent of Upper
Second-Class Honours g) Work experience will be an
or “Distinction” added advantage
First name: Middle names: Surname:
1. YOUR INFORMATION
Gender: male female Nationality:
(Attach passport copy or national
ID)
Date of birth: Marital status: Physical Address:
Country of residence: Email address:
Passport/ National ID number: Telephone number(s) (include country
code):
(Use the same for all the programmes
applied to)
Highest academic qualification: From (school/ university):
(Attach certified copies of high school certificate/ all
university degree certificates and transcripts)
Completion year:
Financial status: dependent (if you're dependent on your parents or guardian for
financial support,
e.g. housing, groceries, etc.)
independent ( if employed, married, etc.)
Note:
If you are a dependent applicant, proceed to Section 2a
If you are an independent applicant, proceed to Section 2b.
2a. IF YOU ARE A DEPENDENT STUDENT
Names of your parents/guardians:
Telephone contact of your parents/guardian:
Education level of parents/guardian:
Expected family contribution per year :
(i.e. estimate of parent(s)' or guardian(s)' ability to contribute to the expenses associated with
your university education).
Parents/ guardian income:
(Please provide evidence e.g. bank statements, pay slip, etc.)
Source of parents/ guardian income:
Family size:
(Number of siblings)
Number of siblings in college:
Parents/ guardian assets:
(such as land, buildings, vehicles, businesses, bank assets, etc.)
Age of the older parent/ guardian:
Do you have any disability? yes no
(If yes, describe and provide evidence such as a medical report)
2b. IF YOU ARE AN INDEPENDENT STUDENT
Expected Personal contribution per year:
(i.e. estimate of your ability to contribute to the expenses associated with your university
education).
Student income:
(Please provide evidence e.g. bank statements, pay slip, etc.)
Source of income:
Number of dependents (if applicable):
(Provide evidence such as birth certificates, marriage certificate, etc.)
Number of dependents in college:
Personal assets:
(such as land, buildings, vehicles, businesses, bank assets, etc.)
Do you have any debt? yes no
(If yes, how much and what was the use of the money?)
3. PROGRAMME(s) APPLIED TO
a. University(ies): Country(ies):
b. Programme(s):
Please summarize your three most recent employments or gainful engagements.
4. WORK EXPERIENCE
# Institution Dates Position held Responsibilities
10. 5. REFEREES
11.
Please provide the following information for two referees who can provide information on your
qualifications, experience and financial status and attach their reference letters to your application.
Referee 1 Referee 2
Title and Name:
Institution/Organization:
Position:
Physical Address:
Email address:
Daytime telephone number:
Mobile phone number:
What is his/her relationship to you?
12. 5. NEXT OF KIN
13.
Please provide the following information for next of kin who is able to provide information about
you and is able to locate you in case we cannot reach you.
Name:
Relationship:
Telephone contact:
Email address:
Physical Address:
How long have you known this person?
DECLARATION
I declare that the above information is true and correct to the best of my knowledge. I
acknowledge that any falsehood provided in the above information forms grounds for immediate
disqualification of my application and or termination of the scholarship at any point.
Name of applicant: …………………………………….
Signature: ……………………………………………....
Date: ………………………………………………….…
Note: (1) Applicants may apply to more than one university and programme. The
same Identification Number should be used to all the programmes applied
to.
(2) Applicants with supporting documents (transcripts, certificates among
others) in languages other than English are required to submit both the
originals and copies translated to English language by an accredited
language translation provider.