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MINISTRY OF EDUCATION
REPUBLIC OF VANUATU
MINISTERE DE L’EDUCATION
REPUBLIQUE DE VANUATU
VANUATU GOVERNMENT SCHOLARSHIP - 2016
SCHOLARSHIP APPLICATION FORM - English Version
This application form is to be used by ONLY those who are eligible (as specified within the Eligibility
Criteria) and wish to apply for a scholarship to undertake their study in various in-country and regional
institutions in 2016.
APPLICATION PROCEDURES 1. This form is to be used by ALL applicants including students, public and private sector applicants.
(Note: Public Service applicants must also complete PSC Form 5-2 in the Public Service Staff
Manual, also available on the Ministry of Education & Training’s public website – moet.gov.vu).
Please tick the category that applies to you.
NGO
Student
Public Sector
Private Sector
2. This application form should be completed by the person applying for a scholarship and must be
signed where appropriate.
3. Please use BLOCK LETTERS when filling in the form.
4. Incomplete and late applications will not be considered.
5. You must attach all the required supporting documents together with this form
(see Checklist – Section H).
6. The eligibility criteria are also inserted in this application form, for your ease of reference.
7. Please note that only applicants who are shortlisted will be notified by TSCU.
8. Applications must be received at the TSCU office before 4:30pm, 30th of MAY 2015.
Your application may be hand-delivered or
posted to the address below:
Or you may submit your full application and
all supporting documents electronically to:
Email Address: [email protected]
Postal Address:
2015 Scholarship Application
Training and Scholarship Coordination Unit (TSCU)
Private Mail Bag 9059,
PORT VILA, VANUATU OR
(All email applications must be addressed to the
Principal Scholarship Officer)
Email Subject: 2015 Scholarship Application
Office use only (TSCU) – Please stamp
Date Received
Application Number
Official Stamp
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 1 of 9 SECTION A: APPLICANT DETAILS
IMPORTANT NOTE
Your application will be considered
incomplete if you do not answer all
questions that apply to you in Section A
to Section I of this form. Furthermore, every
applicant will require an email address, as
TSCU will communicate to applicants
electronically.
1. Surname
2. Given Names
Must be the same surname and given name used in your Birth Certificate or Passport
3. Date of Birth 4. Place of Birth
(Please attach a certified copy of your Birth Certificate)
Day
Month
Year
6. Gender (Please tick where appropriate)
5. Island of Origin
Male
Female
8. Name and Contact of Spouse
7. Marital Status (Please tick where appropriate)
Single
Widower/ Widow
Name:
Married
Defacto
Address:
Phone:
Divorced
(Please attach a certified copy of your Marriage Certificate)
(Please attach a Letter of Agreement from your partner)
10. Passport Details (Only complete this
9. Nationality (Please tick where appropriate)
Ni-Vanuatu
Other (Please specify)
Passport Number
section if you already have a Passport)
Expiry Date
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 2 of 9 SECTION B: YOUR CURRENT CONTACT
The scholarship selection process takes several months.
Please give an address where you can be contacted.
12. Contact Information
11. Current Address
(Must complete all applicable fields, including
email address)
................................................................................
................................................................................
Home Phone:
................................................................................
Work Phone:
Mobile Phone:
Email Address:
................................................................................
................................................................................
13. Alternative Address
14. Alternative Contact Information
(Must complete all applicable fields)
................................................................................
Home Phone:
................................................................................
Work Phone:
................................................................................
Mobile Phone:
................................................................................
Email Address:
................................................................................
SECTION C: YOUR EMERGENCY CONTACT Name someone we can contact in an emergency.
16. Relationship to you
15. Name of Person
17. Address of Contact Person
................................................................................
................................................................................
................................................................................
................................................................................
................................................................................
(e.g. Father, Mother, Brother, Sister, Uncle, etc.)
18. Contact Details
(Where this person can be contacted)
Home Phone:
Work Phone:
Mobile Phone:
Email Address:
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 3 of 9 SECTION D: PREVIOUS SCHOLARSHIP 19. Please indicate if you have been previously awarded a scholarship (Please tick where
appropriate)
Yes
No
If Yes, please complete this Section (D)
If No, please go to Section (E)
20. Years on Scholarship
From (Year)
21. Name of Sponsors
To (Year)
i.
ii.
i.
ii.
23. Name of Program and Course of Study
22. Name of Institutions
(e.g. Bachelor of Public Administration and
Management)
iii.
i.
iv.
ii.
25. Qualification Obtained (e.g. Certificate,
24. Have you completed your program?
Year of Study
Yes
Diploma, Degree, etc.)
No
i.
i.
ii.
ii.
26. If your answer to #24 is no, please clarify the reasons for not completing your study
Year of study
Reason for not completing
i.
ii.
(If you were suspended or terminated by your sponsor, please attach a copy of your suspension or termination letter from your
sponsor/institution with your application; Or any other relevant documents justifying your reason for not completing your study)
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 4 of 9 SECTION E: EDUCATIONAL RECORD 27. Educational Attainment (Please attach certified copies of your academic qualifications and transcripts)
Years of
Completion
Category
Institution Attended
Attainments
e.g. 1990 - 1994
e.g. Malapoa College
e.g. Year 10 Leaving
Certificate
Primary School
Year 10 Leaving
Certificate
Year 12
Year 13 or Year 14
Post-Secondary
Tertiary Studies
Others (Please specify)
28. Current Studies (Please provide a letter from your current institution confirming your enrolment at the
institution and your program and course of study)
Name of Institution
Program and Course of Study
(e.g. SPFSC, DAEU, Certificate,
Diploma, Bachelor, Masters,
Doctorate)
Subjects Currently Enrolled In
or Area of Research for Master
and Doctorate Programs
29. Expected Year of Completion of Current Studies
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 5 of 9 SECTION F: PROPOSED STUDY PROGRAM 30. Please read and fill in this section carefully. Clearly state the study program
that you propose to undertake. You should specify the following:
Guide to Complete Table Below:
i.
Program Level
(For example: Certificate, Diploma, Bachelors Degree, Post
Graduate Certificate or Diploma, Masters Degree or Doctor of
Philosophy)
ii.
Course Name
(For example: Education, Agriculture or Engineering, Commerce,
Marine Science, etc.)
iii. Proposed Institution
Name the institution where you wish to study. If you do not
nominate an institution, or if you list an institution that does not
conduct the course specified, the Scholarship Office will nominate
on your behalf the most appropriate institution preferably within the
Pacific Region, (e.g. USP LAUCALA CAMPUS, UPNG, Fiji
National University).
iv. Please note that Combined Programs (BA/LLB or BCom/LLB)
will NOT be accepted.
v.
i.
Program Level
ii.
Course Name
The National Scholarship and Training Board (NSTB) has the
discretion to determine placements in any institution.
iii. Proposed Institution
31. Please provide a statement in no more than 1 page (A4 Size Paper), outlining your goals
and explain how your proposed program of study will benefit you and your country.
32. Please provide your Curriculum Vitae (CV) (All applicants must submit)
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 6 of 9 SECTION G: EMPLOYMENT Only complete this section if you are currently employed.
Others, please proceed to Section H.
33. Provide the Details of your Employer’s Name and Contacts.
(For example: BRED Bank, Ministry of Health, Lycee LAB, Vanuatu Football Federation, etc.)
(For government employees please indicate the Commission you work under e.g. TSC, PSC, Police)
Employer’s Name
Work Phone:
Employer’s Contacts
Mobile Phone:
Email Address:
34. Employer’s Address
Postal Address: Location of Work Place: .............................................................................. ................................................................................ .............................................................................. ................................................................................ .............................................................................. ................................................................................ 35. Title of your Position
36. Number of Years with this Employer
•
Please attach a Letter of Recommendation from your organization
•
Public Service applicants must complete and attach PSC Form 5-2 and
are required to get written approval from their Head of Department and
the Public Service Commission
•
Teaching Service Commission applicants are required to get written
approval from the Head of Department and the Teaching Service
Commission
•
Police Service Commission applicants are required to get written
approval form the Head of Department and the Police Service
Commission
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 7 of 9 SECTION H: CHECKLISTS 37. Checklist of Required Documents that MUST be attached with this Application.
Required Documents that MUST be attached
with this Application
(Only provide those that are applicable to you)
Please tick where
applicable to you
1. Certified copy of your Birth Certificate
2. Certified copy of your Marriage Certificate
3. Letter of Agreement from your partner
4. Copy of your suspension or termination letter or
(SECTION A – Question 4)
(SECTION A – Question 7)
(SECTION A - Question 8)
other documents justifying your reason for not
completing your study (SECTION D – Question 26)
5. Certified copies of your academic qualifications and
6. A letter from your current institution confirming your
7. A statement in no more than 1 page (A4 Size Paper),
8. Your Curriculum Vitae (SECTION F – Question 32)
9. Please attach a letter of recommendation from your
transcripts (SECTION E – Question 27)
enrolment at the institution and your program and
course of study (SECTION E – Question 28)
outlining your goals and explain how your proposed
program of study will benefit you and your country (SECTION F – Question 31)
organization if you are currently employed (SECTION G –
Question 36)
•
•
•
Public Service applicants must complete and attach,
PSC Form 5-2, and are required to get written
approval from their Head of Department and the
Public Service Commission.
Teaching Service Commission applicants are
required to get written approval from the Head of
Department and the Teaching Service Commission.
Police Service Commission applicants are required to
get written approval from the Head of Department
and the Police Service Commission.
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 8 of 9 SECTION I: DECLARATION To be completed and signed by the applicant.
38. Applicant’s Declaration
I declare that:
a. The information provided in this application is correct.
b. I acknowledge that supplying incomplete or false information may result in the
TSCU not processing my application.
c. I have attached the required documents that are applicable to me, which I have
ticked in the checklist in SECTION H.
d. I agree to my institution and/or the Examination & Assessment Unit, releasing my
academic results to the TSCU, for the purposes of:
•
Consideration of a scholarship;
•
Scholarship placement at a tertiary institution;
•
Collection of academic progress reports and results; and
•
On-going monitoring and assessment of my award
e. I agree to sign the indemnity agreement with the nominated financial institution
with regards to the payment of my allowances, if I am awarded a scholarship.
f.
I agree to abide by the Policy of the Vanuatu Scholarship Program, if I am
awarded a scholarship.
g. I agree to abide by the Government of Vanuatu ICT Policies (National ICT Policy
and Cybersecurity Policy), if I am awarded a scholarship.
h. I agree to abide by the rules and regulations of the institution and country of study,
if I am awarded a scholarship.
i.
I have read and understood SECTION I, Paragraphs (a) to (h) of this Application
Form.
Signature of Applicant
Date
Tel: (678) 23708 (TSCU) or 22309 (MOET); Government VOIP No. 4466 (TSCU) or 4464 (MOET), PMB 9059, PORT VILA, Vanuatu Page 9 of 9