Serial No : ..

MINISTRY OF EDUCATION AND HUMAN RESOURCES

REPUBLIC OF MAURITIUS
*******
LOCAL APPLICATION FORM FOR SCHOLARSHIP
(4 PAGES IN ALL)
The completed application form must be submitted to the Scholarships Section of the Ministry of Education and
Human Resources, 1st Floor, IVTB House, Pont Fer, Phoenix, at the time of application, together with the originals and
certified photocopies of the following documents:
(a) birth certificate ;
(b) certificates/ result slips/ transcripts of results/ marksheets of all applicable academic
qualifications, e.g. SC, HSC, Baccalaureate, Diploma, Degree, result slip* etc
Applicants should also submit a write-up/letter of motivation of about 100 150 words concerning the first choice
of study (candidates applying for scholarships in Francophone countries should submit their write-up/letter of
motivation in French language).
Original documents will be returned to applicant after photocopies have been certified correct.
IMPORTANT: Incomplete, inaccurate, inadequate filling of the form or non-submission of documents requested for
may lead to disqualification.
1. Scholarship Applied for
Country:
Level :

Year:. Scheme/Plan...

Post-doctoral
Postgraduate: Ph.D
Masters
Others
Undergraduate
Others: Higher Diploma
Diploma
Certificate
Technical/Training/Vocational/etc

2. Course of Study Applied for (in order of preference)

1.

...............................................................................................

2.

...............................................................................................

3.

...............................................................................................

3. Surname of Applicant :
Other Names

4. Gender: Male

Female

5:

Marital Status: Single

Married

7. Age:.
6. Date of Birth
(by closing date of application)
8. Place of Birth

: ..........................................................

Country : ...........................

9. Nationality
: Mauritian/Other ( please specify) ..........................................................
If naturalised (certificate of naturalisation to be annexed)
Date : ...................................
10. Address : (in Mauritius)
: ............................................................................
Other (for overseas candidates): .............................................................................
11. Telephone No : Residence .......................................

Office ........................

Mobile Phone No (if any):..

Email Address:
12. Present Occupation : Student/Unemployed/Employed/(Other Specify) .........................................
Specify Name of Educational Institution if still studying : .................................................................
13 For Employed Persons Only :
Occupation (Title of Post)
Name of Employer
Address of Place of Work

: .............................................................................................................
: ........................................................................................................
: ..........................................................................................................

14. In case of award of Scholarship is employer agreeable to release:

(letter of release to be submitted)
15.

Yes

No

Educational Records:School Certificate Results

Year : ............................... Examination Centre No : .....................

School Certificate Results

Index No : .................
Cambridge School Certificate

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G.C.E O-Level
(Cambridge/London)
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Overall Aggregate : ............................

Other Qualifications
(Baccalaureate, etc)

..

Cambridge Higher School Certificate Results

Year : .................. Examination Centre No : .................... Index No : ....................
Rank .................... (If Applicable)
Side : Science / Economics / Technical / Arts / Other ***
Subjects

Subject Grade

Paper Grade
3 4 5

Aggregate of Paper Grade

Principal Level:.
.
.
.
Total

Subsidiary Level:General Paper

.
.

General Certificate of Education A-Level (University of London / Cambridge)***

Month : .........................
Year : .........................
Subject

Examination Centre No : .......................

Grade

Subject

Grade

Index No : ...........
Subject

Grade

16. Other Relevant Qualifications (Academic/Professional/Technical)

Undergraduate Qualifications
Qualification Obtained
(in case of degree, state whether
Hons/Special/Ordinary/General)

*** Delete whichever is not applicable

Class/Division/
Mention

Subject

Examining Body

Date/Year

17. Postgraduate Qualifications:

Qualification Obtained

Field of
Specialisation

Class/Division

Awarding Body

Date/Year

18. For Mphil/PhD applicants only:

(i) Research Proposals submitted:

Yes

No

(ii) Proposed Supervisors name (Note: acceptance letter to be annexed):

19. For a Post-doctoral application, please submit proof of research work carried out in the proposed field of study.
20. Have you been previously nominated for a scholarship? YES / NO***
If YES give details as follows:
Country

Scheme

Year

Course of study

Offer accepted

Successful

Offer not accepted why ?

1.
2.

21. Name, Address and Occupation of 3 Referees :

Name

Address

Occupation

Tel No.

1.
2.
3.

1. Signature of Applicant : ...................................

2. Signature of Resp. Party or Agent (for overseas candidate) .............................. Date : ...................
For Office use only :
Submitted on: ....................... Originals Verified by: ................................... Signature: .........
Date:

Seal

Application Accepted
Application Rejected
Remarks (if any): ..
Signature:
*** Delete whichever is not applicable