Refugee Scholarship Form

Refugee Scholarship Form

Application form
Chaya Mushka Seminary has a number of scholarships available for young refugee women who are interested in a year of learning and growth.

Please fill in this scholarship form IN ADDITION to the International Application Form which can be found on the home page of our website.

Please answer the questions below in as much detail as possible to help us assess your eligibility and suitability for a scholarship.

Scholarships are individually assessed and dependent on individual circumstances.
Personal Information
Full Name*

First Name Middle NameFamily Name
Date of Birth*

MonthDayYear
Date
Age*
E-mail*
Phone Number*
Please enter a valid phone number.
Is your WhatsApp Number the same as your phone number?*

YesNo
WhatsApp Number*
Address (Current Postal address) *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Country of Residence*
Citizenship
Please indicate which of the following you have*

Ukrainian PassportUkrainian National Identity DocumentUkrainian Permanent Residency DocumentRussian PassportRussian Identity DocumentRussian Permanent Residency Document
Ukrainian Passport Number
Ukrainian National Identity Document Number
Ukrainian Permanent Residency Document Number
Please write the official spelling of your name as written on the Ukrainian or Russian document, IN ENGLISH*

First Name Middle NameLast Name
Issue Date*

MonthDayYear
Date
Expiry Date*

MonthDayYear
Date
Questionnaire
Please note, the use of Google translate is accepted.
How did you find out about the Ukrainian Scholarship at Chaya Mushka Seminary?*
How will your experience at Chaya Mushka Seminary benefit you?*
In what ways do you think you can add to the Chaya Mushka Seminary program and environment?*
Signature*

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Parent's signature*

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Refugee Scholarship Form

Personal Information

Citizenship

Questionnaire