The University of The West Indies



314325-2762250The University of the West IndiesSports UnitSPORTS SCHOLARSHIP APPLICATION FORMPersonal InformationName: FORMTEXT ?????First Name FORMTEXT ?????Last Name FORMTEXT ?????Middle InitialTitle: FORMCHECKBOX Mr. FORMCHECKBOX Mrs. FORMCHECKBOX MissGender: FORMCHECKBOX Female FORMCHECKBOX MaleID#: FORMTEXT ?????Permanent Address: FORMTEXT ?????Telephone Home: FORMTEXT ?????Cell: FORMTEXT ?????Email: FORMTEXT ?????Date of Birth: FORMTEXT ????? (dd/mm/yyyy)Nationality: FORMTEXT ?????Sports: FORMTEXT ?????Highest Level that you currently compete at: FORMCHECKBOX International FORMCHECKBOX Regional FORMCHECKBOX National FORMCHECKBOX Club FORMCHECKBOX SchoolEvent/Position: FORMTEXT ?????Last School Attended: FORMTEXT ?????Name of Coach: FORMTEXT ?????Coach’s Telephone FORMTEXT ?????Coach’s Cell: FORMTEXT ?????Current UWI StudentsFaculty: FORMTEXT ?????Major: FORMTEXT ?????Year of Study: FORMTEXT ?????Expected Graduation Date: FORMTEXT ?????Sporting InformationSporting AchievementsWe need to obtain a good picture of your sporting standard. Please give details of your top 5 achievements including recent performances, representative honours and sporting achievements excluding The University of the West Indies Representation. Please then list any other sporting achievements you feel are relevant to your application. If you need to, please continue onto a separate sheet.Achievement Date1. FORMTEXT ????? FORMTEXT ?????2. FORMTEXT ????? FORMTEXT ?????3. FORMTEXT ????? FORMTEXT ?????4. FORMTEXT ????? FORMTEXT ?????5. FORMTEXT ????? FORMTEXT ?????UWI Sporting AchievementsPlease give details of recent performances, representative honours and sporting achievements during Representation at The University of the West Indies.If you need to, please continue onto a separate sheet.Achievement Date FORMTEXT ????? FORMTEXT ?????Future PerformancePlease detail your short term aspirations and long term goals. FORMTEXT ?????Sporting MiscellaneousPlease provide a list of clubs you are are/have been a member of, coaching qualifications, positions of authority etc. ReferencesPersonal RefereeName: FORMTEXT ?????First Name FORMTEXT ?????Last Name FORMTEXT ?????Middle InitialTitle: FORMCHECKBOX Mr. FORMCHECKBOX Mrs. FORMCHECKBOX MissAddress: FORMTEXT ?????Telephone Home: FORMTEXT ?????Cell: FORMTEXT ?????Email: FORMTEXT ?????Sporting Referee (This reference should confirm your performance at elite level. Ideally this should be from your coach, relevant to the highest level of competition reached.)Name: FORMTEXT ?????First Name FORMTEXT ?????Last Name FORMTEXT ?????Middle InitialTitle: FORMCHECKBOX Mr. FORMCHECKBOX Mrs. FORMCHECKBOX MissAddress: FORMTEXT ?????Telephone Home: FORMTEXT ?????Cell: FORMTEXT ?????Email: FORMTEXT ?????SIGNATURE OF APPLICANT: ________________________________________DATE: ______________________________________When completed this form should be returned to:Mr. Dalton MyersThe University of the West Indies Sports Department4 Gibraltar Hall RoadMona, Kingston 7Jamaica ................
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