c Department of Higher Education Ministry of Education Male’, Republic of Maldives Scholarship Application Form ICCR Scholarships 2015/2016 You should submit the following items with this application form in sealed envelope. 1. 2. Attested originals of all qualifications stated in paragraph 3 (you may attest your copies of qualifications from a government office) A release letter from the employer if you have a bond to serve (WRITE CLEARLY IN BLOCK LETTERS) 1. Personal Name Permanent Address (including Atoll/Island) Current Address M F Sex (recent PP photo) Mobile number Age Date of Birth (D/M/Y) years E-mail Address: Govt. Record Card No. Marital Status ID No.  SINGLE  MARRIED  DIVORCED Number of Children Their ages 2. Employment Date Empl. Post Office Tel Present Employment First Empl. in Gov’t 3. Educational Qualification GCE O/Level & SSC Subject Grade Year GCE A/Level & HSC 1. DHIVEHI Subject 8. Grade Year 2. ISLAM 9. 3. ENGLISH 10. 2. ISLAM 3. 4. MATH 5. 6. 7. 11. 4. Grade Year 1. DHIVEHI 12. 13. 14. Attainment (Certificates received) Institute / Country Subject 5. 6. 7. From To SSC & GCE O/LEVEL (GR. 10) Funding Scheme --- Course / training currently being undertaken Institute Programme Level Duration Date started/End Funding Scheme 4. Desired Course Course name Advertisement / Notice ref. & date (IUL)166-schol/166/2015/8 (25 January 2015) Scholarship Application Form – DHE Level Bachelor’s Degree Country of Study India Scheme ICCR/Aid to Maldives Scheme Page 2 of 2 Page 1 of 2 5. Employment History Post & Office 6. Service Bond Records Nature of Bond (studies / training course / paid leave) Please indicate the name of the organization through which you were trained and the duration of the course From Bond Duration To Date Began Service Field of work Date of Bond Completion Status (completed / deferred / serving) 7. Student Loan Status Do you have an outstanding student loan in the Bank of Maldives or at Department of Higher Education? If Yes, Please submit evidence that repayment is regularly made. Copies of the Bank letters, repayment slips can be submitted as evidence 8. Other Applications to Scholarships in 2011,2012,2013,2014 Course (including level) Office Country Funding Scheme Date Applied Yes No Status: (selected** pending / rejected) * * A p p l i c a n t w i l l b e d i s q u a l i f i e d i f i n f o r ma t i o n i s wi t h h e l d . 9. Parent / Guardian / Spouse Name & Address of  Responsible Parent OR  Guardian OR  Spouse Tel 10. Applicant’s Declaration I ................................................ certify that to the best of my knowledge, all information provided in this application is accurate and complete. I understand that false, misleading, incomplete or omitted information could lead to the invalidation of my application. If my application is accepted, I undertake to abide by the regulations of the Government. Furthermore, rejection of the course after selection (without any valid reason) could black list me with the condition that I may not get any chance to receive a government scholarship for a certain period by the Department of Higher Education. Signature of the Applicant: Date: Please submit the completed form, with supporting documents, in a sealed envelope addressed to: Department of Higher Education Ministry of Education Velaanaage (2rnd Floor Deadline for submission: 72th January 2015 (10:00am) Our Telephone number is: 3341380  Please double check if your application is complete. Are the following documents included? Attested originals of all qualifications stated in paragraph 3…………………………..… A release letter from the employer if you have a bond to serve ………………………… Yes Yes No No Have you ever studied in India Yes No Are you currently studying in India Yes No Have you ever studied under ICCR scholarship Yes Please fill the following information No NOTE 1: You should enclose the application and other documents in a sealed envelope with your Name, Address and Applied Course and Scheme clearly written on the envelope. NOTE 2: Please ensure you obtain a receipt on handover of the documents and note the reference number on the receipt. Scholarship Application Form – DHE Page 2 of 2 Page 2 of 2