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Wells Mountain Foundation, Inc. 25 D Main Street Bristol, Vermont 05443 USA Or wmfscholars@wellsmountainfoundation.org
Family Name: __________________________________________ Given Name: __________________________________________ What do you like to be called?: ______________________________ 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): ______TEL. +254705518642.
EMAIL. josephk.mitei@gmail.com__JOSEPH MITEI, P.O. BOX 352,_______________________ ___________________________________________________________________ __________ ___________________________________________________________________ __________ Proposed Program of Study:
What do you plan to study subject and degree level?
___________________________________________________________________ ___________
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?_____________________________________
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 U.S. Dollars
(Be sure to convert the costs)
School fees: ______________ _____________ Cost of room: ______________ ______________ Supplies: ______________ ______________ Other: (please specify) ______________ ______________ Total: ______________ ______________
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? _________________________________________________________________________ ___ _________________________________________________________________________ ___
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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.
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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 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. (See bottom of page 3) ! 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_____________________________________