Sunteți pe pagina 1din 5



The Wells Mountain Foundation is a public charitable foundation based in Bristol, Vermont, USA, which has been approved under the United States Internal Revenue Service under Section 501(c)(3). The purpose of the Foundation is primarily to support programs and individuals in developing nations or other situations of extreme poverty. Each year the Foundations Empowerment Through Education program provides support to students as they pursue various educational objectives. Support is provided for post-secondary school (college, university, polytechnic, trade school). Support is not provided for graduate degrees or study in the US, UK or other developed countries. Financial support is primarily to cover the costs of the education itself and directly related expenses including books and supplies. Scholarships are generally granted for the full period of study, however, recipients must maintain good grades and provide copies of all semester reports and grades as they are received. The scholarship can be discontinued at any time in the event of unsatisfactory performance. The scholarship awards are determined by the Scholarship Committee of the Board of Directors of the Wells Mountain Foundation and awarded once a year. Applications must be received by April 1, 2013 to be considered for the 2013-2014 school year. We highly recommend that you review the FAQ for Scholars section on our website before you complete the application (see Incomplete applications will be discarded unread. Applicants will be notified if they have been selected as a WMF Scholar by approximately August 1, 2013, with funding for the first semester by September 1. All applications should be mailed (our first choice) or e-mailed to:

Wells Mountain Foundation, Inc. 25 D Main Street Bristol, Vermont 05443 USA Or
Family Name: __________________________________________ Given Name: __________________________________________ What do you like to be called?: ______________________________

Attach your photo here

Date of Birth: _____________ Social Security # or Equivalent ID: ________________________ Address: ___________________________________________________________________ City: _______________Region/State/Province: ________________Country: ______________ Telephone: _____________________ Mobile Telephone: __________________________

E-Mail Address: Please print clearly or type!!______________________________________


Page - 2 Name, Address, Telephone Number, and E-mail Address of the closest living relative (i.e. mother, father, spouse, grandparents, uncle, aunt, etc): _______________________________

_____________________________________________________________________________ _____________________________________________________________________________ Proposed Program of Study:

What do you plan to study subject and degree level? _________________________________

Where do you plan to study name of school and location (city and country)?

Total duration of the program through a degree or certification? _________________________ Have you been accepted to this program yet? _________ If no, when do you expect to receive a letter of acceptance? ___________________________ If you are just beginning this program, what date will your studies begin? __________________ If you are in this program and attending classes, how many years have you completed?_______ What month and year do you expect to finish your studies?____________________________ How many total years will you be in the program?_____________________________________

Your Financial Resources:

Do you have any prospects for employment part-time or otherwise while you are in school or between semesters, when you can earn income towards your educational costs? ____________________________________________________________________________ ____________________________________________________________________________ Our maximum scholarship is $2000, but we do not usually award that high an amount. If we provide less than the total amount you have asked for in this scholarship application, is there any way you can make up the difference, if so how much? (If your costs exceed $2000 and you have no other way to make up the difference, then you should not apply for this scholarship.) ____________________________________________________________________________ ____________________________________________________________________________


Page - 3 What is your best estimate of the costs for your program for one school year? Please do not over-estimate your financial costs. Local currency Tuition: School fees: Cost of room: Supplies: Other: (please specify) Total: ______________ ______________ ______________ ______________ ______________ ______________ U.S. Dollars
(Be sure to convert the costs)

_____________ _____________ ______________ ______________ ______________ ______________

About You: (NOTE: If you fill this out on-line, added lines will not print. Use extra paper if needed.)
Please list and describe prior educational experience including schools you have attended and graduated from, and the course of study. Do not include primary schools. ____________________________________________________________________________ ____________________________________________________________________________ Please list and describe all work experiences: ____________________________________________________________________________ ____________________________________________________________________________ . Please list any volunteer activities you have been involved in. What did you do and, on average, how many hours a month did you participate? ____________________________________________________________________________ ____________________________________________________________________________

Tell us what you plan to do after you complete your education, including where you hope to live. ____________________________________________________________________________ ____________________________________________________________________________ . Essay Question: If you had the power to change three things in your country or in the world, what would you change, and why? Please answer in 500-1000 words, on a separate sheet of paper.

Page - 4

Documents that you must include with your application: Check off these items to be sure you have included them. We will not consider incomplete applications!!
! A brochure or other information on the educational institution that you propose to attend. Do not just give us the schools website address. You may submit information printed from the site, such as accreditation, affiliation, mission statement, and a description of your program. A list of schools is appended to this application form, for which we already have brochures and do not require additional information from you. ! A letter of acceptance from the school, if you have received one. If not, send it to us once you have been accepted, noting that you have already sent in an application. ! Two letters of recommendation from people who know you, but are not family members, such as employers, teachers, clergy, volunteer group leaders, etc., who can tell us about your character and abilities. ! A personal statement of at least 500 words but no more than 1000, telling us about your background, your family, your life experiences, why you chose to study the particular field you are studying, and why you believe you should be favorably considered for this scholarship. This statement is a very important part of our decision making process! Please do not fabricate your life experiences. We can tell. ! The completed essay question. ! Official transcript of grades from secondary school with a key to interpreting the grades. For example, in some countries D means below average and in others it stands for Distinction. If you have already completed one or more years at the tertiary level, please include an official grade report for these studies. Do not include grades from primary or junior high school. ! Results from your national exam, if your country gives this kind of student examination. Please only send in your application once. We will send you an email acknowledgement when it arrives in our office. If you do not receive an acknowledgement after three weeks, email us and ask if we have received it before you send another copy. The best way is to send your application via the mail/post and ask for a return receipt from the postal service.

Volunteer Service
The Wells Mountain Foundation is committed to the importance of volunteer service. We believe volunteer service provides benefits not only to the cause where the time is expended, but also to the volunteer. Applicants for a scholarship should be advised that an award of a scholarship will come with a requirement for some period of volunteer activity by the scholarship recipient at a non-profit organization or school in your country or near your school. I hereby certify that all of the information provided here and in the attached documents is accurate and that this application is complete. If information in this application is found to be false, any scholarship I receive from WMF will be terminated. Your signature__________________________________________Date___________________ Email address_____________________________________


Appendix list of schools for which we have brochures or catalogs:

Africa University, Zimbabwe The Aga Khan University, East Africa Ahmadu Bello University, Zaria, Nigeria All Nations University College, Ghana All Saints University, Dominica The American University in Cairo Bugema University, Luweero District, Kampala Busoga University, Uganda University of Cape Coast, Ghana University of Cape Town, South Africa University of Ghana, Legon Gulu University, Uganda Haramaya University, Ethiopia University of Ilorin, Nigeria IPMC College of Technology, Ghana Kampala International University, Uganda Kwame Nkrumah University of Science & Technology, Ghana University of Kwazulu-Natal, South Africa Liaquat University of Medical & Health Sciences, Pakistan Makerere Business Institute, Uganda Mount Kenya University, Nakuru Manipal University, India Nairobi International School of Theology, Kenya University of Nairobi, Kenya Niger Delta University, Engineering, Nigeria NIIT, Ghana University of Port Harcourt, Nigeria Pwani University College, Kenya Takoradi Polytechnic, Ghana Uganda Martyrs University University College of Education of Winneba, Ghana University of Witwatersrand, Johannesburg Zambia Centre for Accountancy Studies
(Inclusion on this list does not indicate endorsement by WMF.)