SCHOLARSHIP APPLICATION FORM

SCHOLARSHIP APPLICATION FORM

SVANICKER GA-DANGME SCHOLARSHIP SCHEME
SECTION A

Personal Details
Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Age*
Gender*
Place of Birth*
Where you were born
Hometown*
Region*
Nationality*
Religious Affiliation*
Languages Spoken*
Residential Address (GHANA POST GPS)*
Email
example@example.com
Phone/WhatsApp Number*
Please enter a valid phone number.
WEKU
HSE Address
WEKU Shia
HSE Address
WEKU Nukpa
Contact Number
Please enter a valid phone number.

SECTION B

EDUCATIONAL BACKGROUND
Program pursuing*
Student Account Code*
Program duration*
Admission Date*

MonthDayYear
Date
Last Educational Institute Attended*
From
To
Certificate Earned*
School Head
School Address
Phone Number
Please enter a valid phone number.
Email
example@example.com

SECTION C

FAMILY INFORMATION
Father's Name*

First NameLast Name
Telephone*
Mother's Name*

First NameLast Name
Telephone*
Name of Grandfather (Paternal)

First NameLast Name
Home Town of Paternal Grandfather
Current/ Last Residential Address of Grandfather
Provide Last Known Address (If Deceased)

SECTION D

Economic Information
Father's Occupation*
Father's Digital Address*
Father's Email
example@example.com
Father's Phone Number*
Please enter a valid phone number.
Mother's Occupation*
Mother's Digital Address*
Mother's Email
example@example.com
Mother's Phone Number
Please enter a valid phone number.

SECTION E

Emergency/Confirmation Contacts
First Contact Name*

First NameLast Name
Digital Address
Phone Number
Please enter a valid phone number.
Second Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Digital Address

SECTION F

Referees

Fill Referees Data

	NAME	EMAIL	Phone Number	Position
CHARACTER
ACADEMIC

Attachments

Please attach Certified Copies of the under-listed documents. Do not include original copies of your documents. The office will not accept any responsibility for the loss of original documents.
Admission Letter*

Upload Admission Letter
Cancelof
Birth Certificate*

Upload Birth Certificate
Cancelof
BECE/SSCE/WASSSCE Certificate(s)*

Upload Education Certificate
Cancelof
Any other certifacate(s), professional, or other Diplomas

Cancelof
All academic transcripts from institutions/schools attended as well as reference letters should be sent directly to: The Registrar Ga-Dangme Scholarship Fund Valley View University P O Box DT595 Adenta – Accra

SECTION H

Declaration
I, First Name* Last Name* certify that the information herein provided is correct and complete to the best of my knowledge. I accept to be disqualified from the scheme should the information herein given to be found at any time to be false.

That the referees and others mentioned are to provide needed information with regard to any subjects covered by this application. I hereby release such parties of any damage that may result from furnishing such information.

I agree that if offered the scholarship, I, will conform to the policies and Christian principles of the University. These may be liable to change at any time.

I further accept the fact that if granted the sponsorship, I will be subjected to a qualifying (probation) period, which may be extended at the discretion of the University, and will be required to provide additional pertinent information about my nuclear family, if any, and myself.
Sign
Date

DayMonthYear
Date
Should be Empty: