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Prospect Connect Application Form 2024

Prospect connect application form

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mihsuhnineain
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14 views9 pages

Prospect Connect Application Form 2024

Prospect connect application form

Uploaded by

mihsuhnineain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Prospect Connect Application Form

This application form is for students wishing to apply to Prospect Burma’s Prospect
Connect Programme. Please provide the following documentation alongside your
application form:
● Photocopies of High School Certificate and University Graduation
Certificate.

● Reference letters from


two individuals who can
write in support of your
character and
academic abilities.
Please also provide the
contact details of your
referee in the
appropriate section of
the form.
● Photocopies of your Identification documents - either a passport or
identity card that you currently hold.

Prospect Connect
This isa four- months, 100- hour, intermediate/upper intermediate/advance English
online programme with students that live in multiple locations across the country.
Prospect Burma's knowledge partner, EduLink, will provide the online curriculum for
this programme.

During the course all students will also participate in various online workshops led by
Prospect Burma; this will give students an opportunity to interact with the entire
cohort and Prospect Burma team members.

Each student will take an IELTS test at the end of the course in order to determine their
score, and if additional English courses are required. Each student will have the chance
to increase their English score to 5.5 during the four-months programme.

Application Guidelines
Every section is mandatory. If you are unable to provide information, please mark “N/A”
in those specific sections.

1.YOUR PERSONAL DETAILS

Full Name _
Aliases (if any)
Date of Birth
Place of Birth
Gender
Ethnic Origin
Religion
Marital Status
Original Address
Current Address
Guardian Phone for
Emergency Contact
Personal Phone
Email
Facebook link
Do you have any form of YES NO
physical conditions/
disabilities?
If yes, could you tell us by Blindness
selecting the following
points?
Low-vision
Leprosy Cured persons
Hearing Impairment (deaf and hard of hearing)
Locomotor Disability
Dwarfism
Intellectual Disability
Mental Illness
Other physical disability
Speech and language disability
Others (Please specify here)
Is there anyone in your YES NO
family members who
have conditions/
disabilities?
If YES, please tell us more
about his/her condition?

2.PREVIOUS EDUCATION

a.High School Information

Name of the High School

Location of the High School

Year of Exam Passed


b.University Information

Name of the University

Location of the University

Final Year Exam Result Known


(Yes/No)

If yes, Final Year Passed date

If no, Expected Result Date

Start year and end year of


university
(eg., from 20XX to 20XX)

If there are any year gaps between your university starting and ending years, please clarify the
reason.

c.International Experience

Have you travelled to any


other countries? (Yes/No)
If yes, please provide details
including when, where and for
what purposes.
3.REFEREES

Please provide the details of a referee who can vouch for your character and abilities.

a.First Referee

Name

Employer

Position

Address

Telephone

Email

b.Second Referee

Name

Employer

Position

Address

Telephone

Email

4.FAMILY INFORMATION

If either or both parents are retired or deceased, please give their previous occupation.

Father
Name: Occupation:
State/Region and Country of residence:
Is your Father Retired? Is your Father
(Yes/No) deceased?
(Yes/No)
Mother
Name: Occupation:
State/Region and Country of residence:

Is your Mother retired? Is your Mother


(Yes/No) deceased?
(Yes/No)
Have either of your parents attended
university? (Yes/No)
If yes, please give details of your parents' education below (Course; Level eg. Non- formal
education/Middle School/High School/undergraduate/postgraduate/doctoral, and Country):

Have any of your siblings attended


university? (Yes/No)
If yesplease give details of their education below (Name; Course; Level eg.Non- formal
education/Middle School/High School/undergraduate/postgraduate/doctoral, and Country):

5.SMARTPHONE ACCESS
Do you have access to a smart phone? YES/NO

If YES, please let us know the regular number of hours per week you would be able to
access that phone.

6.INTERNETACCESS
Do you have wifi/fiber internet access in your place? YES/NO

If NO, please mention how you will join the online class delivered by this programme?

7.BIOGRAPHY
In an essay of 300 words or less, please give details about your background and
childhood, by referencing your education journey and any service- oriented activities in
your community that you have been involved in. Please highlight how your journey and
any activities undertaken have shaped your worldview, and your interest in furthering
your education.

8.FUTURE PLANS
In an essay of 300 words or less, please tell Prospect Burma about your short- term and
long- term plans, including how you intend to contribute to your community and
Myanmar’s future. Please discuss how attending this course would affect both your
short- term and longer- term plans.

9.DECLARATION

To the best of my knowledge,


the information I have
presented in this application
is accurate. I can confirm
that I have not knowingly
fabricated or falsified any
information provided in this
document. I understand that
if I am caught providing false
information my Prospect
Burma scholarship will be
cancelled with immediate
effect, and I will be
blacklisted from applying for
future scholarships from
Prospect Burma.

Signed:
Date:

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