Scholarship Application Form

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Council for World Mission Scholarship Application Form Read guideline carefully before completing the form. 1. The application must include the following: A) Completed CWM application form.

1 Council for World Mission Scholarship Application Form Read guideline carefully before completing the form. 1. The application must include the following: A) Completed CWM application form. B) A copy of the acceptance letter from the institution (if applicable). C) Completed Medical Examination form. D) Itemised budget and or a certified copy of costs/fees from the institution where the study will take place. E) Ensure Part B is completed by your General Secretary. F) Ensure Part C, the budget is completed. The sample budget is an example only, please include a clear and full budget. 2. Ensure all supporting documents as name above are enclosed with the completed form including a passport sized photograph. 3. Ensure that the application is returned to CWM by the submission date. 4. Applications must be submitted by the Church office. 5. Submission dates for June: January 15 th, for November: July 15 th. Return Completed application form to: Personnel and Training Council for World Mission, Ipalo House Great Peter Street London SW1P 2DB United Kingdom

2 COUNCIL FOR WORLD MISSION SCHOLARSHIP APPLICATION FORM Application should reach CWM by 15 January or 15 July for decision at the Trustee Body. Use separate sheets of paper to provide more information if needed. 1. PERSONAL DETAILS (exactly as they appear on your passport) Name of candidate Signature of candidate: Church Date Name in BLOCK letters Male Female Surname (Family name) Middle/First name(s) Title e.g. Mr, Mrs, Rev Contact address Telephone: Fax: PART A: ABOUT THE CANDIDATE AND COURSE/STUDY PROGRAMME Date of birth Place of birth Nationality Name of spouse Profession of spouse Children s names Date of birth Gender Next of kin Relationship Address Telephone CWM will hold your details on file in order to process your application and to send you relevant information. We may wish in the future to send you further information about CWM or seek your views about its work. If you do not want your records to be used for this purpose, please tick this box. Your details will not be given to a third party outside CWM without your consent.

3 2. a. Education Use separate sheet if needed Colleges, universities attended Dates Qualification attained b. If ordained, give date of ordination 3. Work experience (Use separate sheet if needed) a. Employer Post held Dates b. Please give details of your present job. 4. What is the formal title of the study programme? 5. Please give a full description of the programme (Such as nature, length of courses, etc. For research study provide as much details as you can).

4 6. What is the name and address of the institution where the training or study is to take place? Provide postal, street and address, telephone and fax numbers. 7. a. Why has this institution been chosen? b. What other institutions have you considered? c. What is the advantage of this institution over the others? d. If you have not looked at any other institutions, why? 8. a. What is the intended length of the programme? b. When do you propose to start and finish the programme? (Give month and year) Start: Finish: 9. a. Is your family accompanying you on this study programme? b. If no, how will your family be supported while you are away? 10. Have you secured admission in this institution? Yes. No. Tick one only If not, how far into the process are you? Provide supporting documentation Please tick box if enclosing supporting document with the application. 11. Have you received a CWM scholarship before? If yes give details.

5 12. Give a brief account of how your work experience and the the proposed study would benefit your Church and yourself. Include how this programme will enhance your work upon resumption. (Use separate sheet if necessary) PART B: TO BE COMPLETED BY THE CHURCH AUTHORITY Name of Candidate Church

6 The process of approval by Trustees could be delayed if you cannot clearly demonstrate the connection between this application and your mission priorities and your human resource development plan. 13. List the ways in which this application fits your Churches mission priorities and human resource plans (if one exists). a. Mission Priorities b. Human Resource Plan 14. Upon completion of this study programme identity the ways in which the candidate can be used. (Use separate sheet if necessary) 15. Is there a job for the student to return to? Yes/No If you answered yes what is the job? If you answered no? Please explain why you are applying for a scholarship. 16. If this application is granted, what is the minimum period of in-service work the candidate will be required to complete after he/she completes the study programme? 17. Please prioritise your applications if you have more than one, using 1, 2, 3... where 1 indicates first priority.

7 18. a. Which church body has authorised this application? Please quote from the minutes the reference for the decision. b. Who will be responsible for overseeing this application? 19. Have you obtained costs from the institution? If yes, please include with your application a copy of the official letter from the institution detailing costs. If no, please explain why.

8 Part C: ABOUT THE BUDGET (a) Below is a basic outline which may not enable a clear detailed budget. Please do include a separate sheet in order to provide as much information as possible. (b) If the course is for one academic year or less please indicate. (c) If the study is longer than one academic year, provide details for each year and a grand total. 20. Breakdown of total costs What currency is this budget in? Airfares a. for candidate Give details below b. for the rest of the family Year 1 Year 2 Year 3 Tuition fees Accommodation Does this amount include family? yes/no Maintenance Does this amount include family? yes/no Other allowances Give details below Holiday expenses Contingencies Total cost of scholarship How much requested from CWM Other bodies approached for financial support (this is encouraged) Amounts assured 21. Other relevant information on costs *Airfares *Other allowance 22. Name (in BLOCK letters) and position of person submitting the application on behalf of the church. Signature of the church officer Date Official stamp of the church

9 Any other information you would like to tell us:

MEDICAL EXAMINATION FOR OFFERS OF OVERSEAS SERVICE OR SCHOLARSHIP APPLICATION THROUGH CWM. 1. Name: Sex: 2. Date of Birth: 3. How long have you known the applicant? 4.

What infectious diseases has the applicant had? 8. General condition: 9. Weight: Height: 10. Any eye defects? If so are spectacles worn and satisfactory? 11. Any ear disease?

10 MEDICAL EXAMINATION FOR OFFERS OF OVERSEAS SERVICE OR SCHOLARSHIP APPLICATION THROUGH CWM. 1. Name: Sex: 2. Date of Birth: 3. How long have you known the applicant? 4. Have you attended him/her professionally? If so, what complaint? 5. Any family history of disease? 6. Any serious operations, injuries or illness in the past? 7. What infectious diseases has the applicant had? 8. General condition: 9. Weight: Height: 10. Any eye defects? If so are spectacles worn and satisfactory? 11. Any ear disease? Any hearing defect? 12. Are mouth and throat healthy? 13. Are teeth well cared for? 14. Pulse rate: Blood pressure: 15. Are heart and lungs healthy? Result of chest x-ray: 16. Any abdominal signs or symptoms? Any sign of hernia?

11 17. Urine: Any albumen Any sugar? 18. Any organic, nervous or other disorders? 19. Any functional disorders? 20. Is the applicant emotionally well balanced? 21. Do you consider that they are any medical reasons why the applicant should not go abroad for 2 years or more? 22. Does the applicant need any special diet or regular medical treatment of any kind? Signature... Date... Address of examiner:

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