Public Service BursaryAward Application Form

The Public Service Bursary Award Scheme awards up to 15 scholarships annually to Bermudians pursuing post-secondary academic qualifications in a discipline, which has been identified by Government Departments, that meets the future needs of the Department. This ensures a well trained cadre of people to fill positions within the Public Service. The bursaries are valued at $10,000 per annum.

To be completed by the applicant in his/her own handwriting and returned with the supporting documentation specified in Section 27 of this form to: The Bursary Co-ordinator, Department of Human Resources, 3rd Floor, Ingham and Wilkinson Building, 129 Front Street, Hamilton HM 12, to arrive no later than 4:45 p.m. the last Friday in April.

Students reapplying must provide a completed application form with ALL required documents.

Incomplete, illegible, inaccurate, fraudulent or late applications will be disqualified from consideration.

APPLICANT INFORMATION

1. Applicant’s Name in full: Last First Middle

2. Date of birth: Age: Day Month Year

3. Place of Birth:

4. Home Address (Bermuda):

5. Mailing Address (Bermuda):

6. Telephone (Bermuda): Home Cell

7. Address (Abroad):

Telephone Nos (Abroad): Home Cell

E-mail address: School Personal

PARENT / GUARDIAN INFORMATION

8. Parent/s or Guardian/s name(s) in full:

9. Address of Parent/s or Guardian/s in full:

Telephone Nos: Home Cell Work E-mail address: Work Personal

SPOUSAL INFORMATION

10. Spouse’s name in full:

Telephone Nos: Home Cell Work

E-mail address: Work Personal

ACADEMIC INFORMATION

11. Schools Attended(a) Secondary Dates From To

(b) College/University

12. Qualifications Attained (e.g. G.C.E., G.C.S.E., A.P.E., B.A., etc.) Date Awarded

13. Current Place of Study:

14. Current Programme: Expected Date of Graduation

15. Have you been admitted to a College/University for the upcoming academic year? YES NO

16. If yes, give name of College / University:

17. Please state your degree programme:

18. Describe the course of study you propose to undertake and why. (Use additional paper at the back of the form if necessary)

19. Duration of this programme:

20. Expected Date of Graduation:

21. If not already in College / University, please state present occupation:

22. List the Government and Non-Government Award(s) you currently hold or have held:Name Value of Award

$List years for which the

Award is tenable

23. Which Government and Non-Government awards are you applying / reapplying for during this academic year? (Use additional paper at the back of the form if required)

Name Value of Award$

List years for which the Award is tenable

24. Are you under any obligation to work for any employer on completion of your studies? YES NO

25. If yes, please explain:

REQUIRED DOCUMENTATION

26. In accordance with the Regulations, please ensure that the following information and documentation is included with your application:

a. Birth Certificateb. Bermudian Status Certificatec. A recent Medical Certificated. Evidence of no less than five (5) years of schooling in Bermuda e. College/University Letter of Acceptancef. Bermuda Secondary Certificate (BSC or BSSC) transcriptg. Official, up-to-date Transcript from College / Universityh. Statement of Character and Deportmenti. Copies of your education/qualification; certificates/diplomas as listed hereafter

27. I have read and understand the Regulations governing the Public Service Bursary Awards:

YES NO

28. Provide any extra curricular activities you have participated in (Include timeframes, positions held, etc.) Volunteer Activities:

Memberships and/or Associations:

Sports:

29. On the last page of this application, please describe in your own words: (a) your career aspirations. Indicate the extent to which you believe those aspirations might be fulfilled within the Public Service and (b) Special qualities or circumstances that qualify you for this award. (Use additional paper if required.)

NOMINATION OF SURETIES

FIRST SURETY:

Full Name (PRINT):

Home Address:

Mailing Address:

Telephone Nos: Home Cell Work

E-mail address: Work Personal

SECOND SURETY:

Full Name (PRINT):

Home Address:

Mailing Address:

Telephone Nos: Home Cell Work

E-mail address: Work Personal

31. I certify that the information contained in this application is accurate and truthful and understand that should the information provided prove to be incorrect or misleading, then any Public Service Bursary awarded will be withdrawn and/or not considered.

Applicant’s Signature: Date:

For use by Department of Human Resources Only:Documentation Received:

Birth Certificate Academic Qualifications Surety 1

Bermudian Status Certificate College Acceptance Letter Surety 2

Career Aspirations Medical Certificate

Official Transcript BSC Transcript

Evidence of 5 years schooling in Bermuda Statement of Character and Deportment

Department/Ministry:

Date: Reply by:

Recommendation:

P.S.C. Date:

ADDITIONAL PAPER

CAREER ASPIRATIONS