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Visions Scholarship Program: Youth Application for Scholarship Funds Description of the Visions Scholarship Program: The Visions Scholarship

Program is designed to help compliment all other Visions efforts by providing youth with assistance in order to help secure employment and promote professional success. Youth between the ages of 14 and 24 are encouraged to apply for small scholarships to do something that not only interests them, but also serves their future academic or career goals. Ideas such as taking a computer training or English course, attending a special conference or training session, seeking assistance to help manage the costs of school or work-related travel, starting a small business, etc. are just a few of the MANY ideas youth might pursue. First-time applicants must specify within this application what they intend to do with the money and how exactly it will be spent. Successful applicants may receive the full or partial amount they requested. All applicants, regardless of whether their application is approved or denied, will receive notification from Visions in a timely manner.

PART I: BACKGROUND INFORMATION Full Name:______________________________________________ Date of Birth (DD/MM/YYYY):____/_____/_________ Sex (circle one):

Male

Female

Mailing Address:_______________________________________________ _______________________________________________ Telephone # (if any):______________________________ Email Address (if any):______________________________ Check one: First time applicant Returning applicant  Number of times previously applied:____________  Number of times application was accepted:___________


Are you currently living in a children’s home/orphanage?________ If so, which one and where:____________________________________

PART II: EDUCATIONAL BACKGROUND Please list all schools you have attended and their locations: School 1:______________________________________________ Location:______________________________________________ School 2:______________________________________________ Location:______________________________________________ School 3:______________________________________________ Location:______________________________________________ School 4:______________________________________________ Location:______________________________________________ What is your highest level of education achieved (Primary, O/L, A/L)?:__________ If you have passed your O/L exams, please provide subjects taken and marks received: Subject:_______________________ Mark:___________________ Subject:_______________________ Mark:___________________ Subject:_______________________ Mark:___________________

Subject:__________________ Mark:__________________ Subject:__________________ Mark:__________________ Subject:__________________ Mark:__________________

If you have passed your A/L exams, please provide subjects taken and marks received: Subject:_______________________

Subject:__________________


Mark:___________________ Subject:_______________________ Mark:___________________ Subject:_______________________ Mark:___________________

Mark:__________________ Subject:__________________ Mark:__________________ Subject:__________________ Mark:__________________

Please list any school activities or organizations you have been involved with:

Please list any community activities or organizations you have been involved with:

If you have any work experience, please list it here: Employer:___________________________ Description of duties:_____________________________________ _____________________________________________________ _____________________________________________________ Employer:___________________________ Description of duties:_____________________________________ _____________________________________________________ _____________________________________________________

PART III: PROJECT PROPOSAL & FUNDS REQUEST Amount Requested:___________________________ For what purpose(s) are you requesting this money? How will the money be used?: ______________________________________________________________


______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ When will your project or effort be completed? __________________________ ______________________________________________________________ Please list any specific details for how the money will be used. For example: LKR 8,000 for computer training course LKR 2,000 for transportation to training center LKR 1,000 for supplies TOTAL: LKR 10,000

______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Any other details you would like to add about your proposal:__________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________


PART IV: STATEMENT OF UNDERSTANDING FOR GRANTING OF SCHOLARSHIP FUNDS Please check all the boxes to agree to each and then sign below: I verify that I am between the ages of 14 and 24 I agree to use the money Visions gives to me only for the purposes specified in this application; if anything in my proposal changes, I will immediately notify Visions staff and seek approval of these changes from Visions before proceeding to spend any of the funds I verify that all information contained within this application is true and correct; and I understand that if any information in this application is found to be false, Visions may strip me of my scholarship funds

Signature:_______________________________________

Date:_________

Printed Name:____________________________________________________


Scholarship Application 2009