First

9a. Contact Number/s:_______________________________________

VM FOUNDATION MASTER PLAN “HEAD-START” SCHOLARSHIP

APPLICATION FORM

BEFORE COMPLETING THIS FORM, PLEASE READ THE REGULATIONS.

Each candidate should complete one copy of this form. The application form and supporting documents listed below should be returned to the nearest Branch of The Victoria Mutual Building Society (VMBS) or by email at vmfoundation@myvmgroup.com

SPECIAL INSTRUCTIONS |

1

The documents to be submitted along with the Application Form are: 1. A letter of reference (stating grades) or transcript from the candidate’s school.

2. A typed (double-spaced/letter-size) three to five hundred (300-500) word essay on the topic:“My Role in Community Development”.

(Please complete Scholarship Authorization and Certification overleaf)

VMFMP20

The VM Foundation Master Plan “Head-Start” Scholarship, is a one time scholarship offered to students who will be starting the final year of an Undergraduate or Masters Degree programme.

Applications for the 2020 VM Foundation Master Plan “Head-Start” Scholarship Programme closes on Friday, June 26, 2020.

Day Month Year

1. Name: _____________________________________________________________________________________________First Middle Name/s Surname

2. Applicant’s Contact Number/s: ________________________________________________________________________

3. Date of Birth: _______|_______|_______ 4. Sex: Male □ Female □ 5. Nationality:__________________________

6. Home Address: _____________________________________________________________________________________

_______________________________________________________________________________________________________

7. Mailing Address ______________________________________________________________________________________________________

______________________________________________________________________________________________________

Email Address:_______________________________________________________________________________________8.

12.

Name of Tertiary Institution:___________________________________________________________________________

13.

Course of Study:____________________________________________________________________________

List all Clubs, Societies, Volunteer Initiatives, Teams that you participated in:

___________________________________________________________________________

___________________________________________________________________________

9. Middle Name/s Surname

9b. Relationship:___________________________

10. Name of Past School:__________________________________________ Parish:___________________________

11.

List how you will /plan to account for the remaining portion of your tuition. Should there be any uncertainty regardingthe exact figure, please provide an estimate :

SOURCE (S) $

TOTAL EXPECTED SUPPORT

14.

10a.

Emergency Contact Name:_____________________________________________________________________________

VMFMP20

2

In accepting the VM Foundation Master Plan “Head-Start” Scholarship,

I, __________________________________________, hereby grant and assign to Victoria Mutual Group

forever and throughout the world, the irrevocable, non-exclusive right to use my name, voice, photograph,

images or likeness for any promotional, commercial, advertising, or other purpose as VM may desire, in

all media, whether now known or hereafter devised, throughout the world in perpetuity (including,

without limitation, in any print media or publications, on the Internet, on basic cable, free and pay television

systems worldwide and all supplemental market uses, video cassette, DVD and/or video disc), and in

all forms (including, without limitation digitized images), without further compensation or any limitation

whatsoever, unless prohibited by law.

If any selected VM Foundation Master Plan “Head-Start” Scholarship winner cannot be contacted, is ineligible or fails to complete LOCAL

tertiary education, he/she will forfeit the VM Foundation Master Plan “Head-Start” Scholarship and the VM Foundation will select an alternate

winner.

I, _________________________________________________, hereby certify that I am 18 years or older and I have read and fully understood

the above terms and conditions and I accept them. In addition, the information, which I have given to the above questions, is true and

complete. I understand that any misrepresentation by me could lead to my disqualification as a candidate for this VM Founation Master Plan

“Head-Start” Scholarship.

___________________________________ ___________________________ _______________________(Signature of Applicant) Witness (Date)

VM Foundation Master Plan “Head-Start”Scholarship Authorization & Certification

(FOR STUDENTS 18 YEARS AND OLDER)

Each candidate must:

1. Be an active VMBS saver (that is, their savings account should notbe dormant).

2. Be a final year student attending a tertiary institution and pursuing anundergraduate or masters degree.

3. Have completed the Master Plan Scholarship Application Form andsubmitted it to a VMBS Branch on or before the closing date.

4. Submit a typed (double-spaced/letter-size), three to five hundred(300-500) word essay on the given topic: “My Role in CommunityDevelopment.”

6. Attend an interview (If the Foundation requests)

Applicants, who have maintained an exemplary academic record and also play an active role in the development of his/her institution or community, will have a significant advantage.

The Scholarship Selection Committee will select one (1) candidate to receive the award which will be o�ered for final year studies with a ceiling of JMD$200,000.

REGULATIONS GOVERNING THE GRANTING OF THE VM FOUNDATION MASTER PLAN “HEAD-START” SCHOLARSHIP

5. Not be a recipient of any other Scholarships for the given year for tertiarystudies.

7. Be a Jamaican.

Signature:

Date:_______|_______|_______

Day Month Year

STAMP/ SEAL

THIS SECTION IS MANDATORY AND MUST BE VERIFIED BY VMBS BEFORE AFFIXING SEAL

VMBS Account Number: ___|___|___|___|___|___|___|___|

Type of Account:

Name(s) on Account:

Branch Name:

FOR OFFICAL USE ONLY

MEMBER ACCOUNT VERIFICATION