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Scholarship Application: A-Level Program

Please complete this form and return it to fqmscholarships@ by 6 October 2019.

If you pass the initial selection you will be invited to write a scholarship assessment which will include an Aptitude Test and a Maths and English exam.

|Details of Applicant: | | | |

|First Name |      | |Surname |      |

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|Date of Birth |      | |Gender |M |

|Nationality |      | |Your Cell No |      |

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|E-mail address |      | |School |      |

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|In what year did you, or will you be, completing school? |      |

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|Current Location |      | |Permanent |      |

| | | |Address | |

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|Details of Guardian 1 (Father): | | | |

|First Name |      | |Surname |      |

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|Relationship to child |      | |Employer |      |

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|Position at work |     name |

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|E-Mail |      | |Cellphone |      |

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|Details of Guardian 2 (Mother): | | | |

|First Name |      | |Surname |      |

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|Relationship to child |      | |Employer |      |

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|Position at work |     name |

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|E-Mail |      | |Cellphone |      |

Results and Achievements:

Please provide details of the grades or marks you obtained in recent reports.

|Subject |Actual Results |Forecast Results IGCSE / GCE |

| |Mock Exams 2019 |2019 |

|English |      |      |

|Mathematics |      |      |

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Please attach your latest school report

Academic Recognition

Please list and give details of any relevant academic achievements or acknowledgement that you have received in recent years. (Awards, Certificates, rank order in grade etc) Please attach any evidence you may have:

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Motivation

It is generally not a requirement that you have A-Level qualifications to enter an institution of higher learning in Zambia. Please detail your reasons for wanting to study A-Levels.

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Future Plans

Write a paragraph entitled “My Future”.

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Provisional Subject Choice

In your first year (AS Level) you will be required to study 4 subjects and in your second year (A-Level) 3 subjects. Indicate which 4 subjects you would like to study in your A/S year.

|Option Group |Subjects |Your Choice |

| |Biology |      |

| |Business Studies | |

| |Chemistry | |

| |Design & Technology | |

| |English | |

| |Geography | |

| |Mathematics | |

| |Physical Education | |

| |Physics | |

| |Travel & Tourism | |

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Signed Applicant Date:

Signed Guardian Date:

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