Scholarship Application - Heart Disease Prevention and Training Center

Apply For Scholarship

STUDENT INFORMATION

Name *

First

Last

Numbers

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Home Phone

Mobile Phone

Email *

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Date of Birth *

No. of Children

APPLICANT REFRENCES

Reference 1

Name *

Address *

Phone *

Email *

REFERENCE 2

Name *

Address *

Phone

Email *

REFERENCE 3

Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

Email *

APPLICANT'S ACADEMIC DATA

SECONDARY SCHOOL EDUCATION YEAR OF COMPLETION

Certificate Obtained

WAEC
NECO
GCE
NABTEB

Current college/University

Current Course of Study

Contact person at the University

Name *

Email *

Phone

Certificate to be obtained

Do you live with a parent or other adult relative? (Do not include your spouse)

I give the Scholarship Committee(s) permission to review my academic record

By signing this form I authorize the use of my name of the scholarship(s) that I receive to be used in the
Scholarship Awards Program, released to the public, and published on the College website, if I am selected as a
scholarship recipient.

FINANCIAL INFORMATION

Estimate your total expenses and resources

Marital Status

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Month

Estimated Expenses

Tuition and Fees (N)

Rent & Utilities (N)

Food (N)

Books & Supplies (N)

Transportation (N)

Other

Total (N)

Complete the following:

Current Employer

Position

Hours/week

Salary/Month (N)

ACADEMIC ACTIVITIES AND HONORS

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COMMUNITY ACTIVITIES AND EXTRACURRICULAR ACTIVITIES

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ITEMS NEEDED FOR APPLICATION

SCHOLARSHIP APPLICATION FORM

PERSONAL RESUME OUTLINING ACHIEVEMENTS

CHARACTER LETTER OF REFERENCE

ACADEMIC LETTER OF REFERENCE

300-WORD PERSONAL COMMITTMENT NOTE ON PLAN TO HELP YOUR
COMMUNITY AFTER GRADUATION

APPLICANT NATIONAL IDENTITY CARD

*We will accept a maximum of four letters of reference

RESOURCES YOU EXPECT TO USE IN THE ACADEMIC YEAR

Ex 2021/2022

This section must be completed in full or your application will NOT be processed

Student Contribution from Income/ Assets (N)

Parent / Guardian / Family Contribution (N)

Other Contributions

(Please specify below: E.g.: Student loans, external grants/scholarships, etc)

Year

Estimated Income

Aid from Parents/Relatives (N)

Financial Aid (N)

Your Earned Income (N)

Spouse earned income (N)

Other Benefits (N)

Other income (N)

Total (N)

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Other

Total Resources Available for the Academic Year (N)

I declare that the information provided above is complete and accurate to the best of my knowledge. I
understand that the results from this form will; be used solely for the determination of eligibility for
institutional grant/bursary assistance by the HDPTC Office of Financial Aid.

(N)

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Student's Signature

Enter your full name

Date

DD/MM/YY