IVERSI

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NTECOST

PENTECOST UNIVERSITY COLLEGE Please affix

COLLEGE
your passport
SCHOLARSHIP APPLICATION FORM picture here
PE

GHANA
EM
POW VE
ERED TO SER

INSTRUCTIONS:
Please fill all portions of this form and attach all relevant documents to it. This should reach the
Scholarship Office not later than 30th July each year. Send this to the address at the end of this
application. (You risk losing your chances of success if you do not complete your application
properly.)

SECTION A
PARTICULARS OF APPLICANT
SURNAME DATE OF BIRTH
DD MM YYYY
FIRST NAME NATIONALITY

OTHER NAMES GENDER

MALE FEMALE
DEGREE ENROLLED STUDENT ID

STATUS
NEW STUDENT TO PUC
PUC CONTINUING STUDENT LEVEL
GRADE POINT AVERAGE (GPA): __________ (on a 4.0 scale)
(For Continuing Students: Attach proof of GPA. Your most recent official school transcript is required)

SECTION B
MAILING AND COMMUNICATION ADDRESS
POSTAL ADDRESS: TELEPHONE NO.:

COUNTRY: EMAIL:

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SECTION C

WHICH SCHOLARSHIP ARE YOU APPLYING FOR (please tick appropriate box)
FULL SCHOLARSHIP
HALF SCHOLARSHIP
1/3 SCHOLARSHIP

SECTION D
EDUCATION (list in order of time, since Senior High School)
Name of institution and place Major field of Years of study: Certification Grade
of study study (Month/Year)
From To

SECTION E

RELIGIOUS BACKGROUND
NAME OF RELIGION

NAME AND ADDRESS OF RELIGIOUS LEADER TELEPHONE NUMBER

SECTION F
PERSONAL VALUES (Briefly state what your core personal values are)

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SECTION G

INFORMATION ABOUT FATHER

Full Name: ……………………………………………… Date of Birth:…..…/…..…/…..........(dd/mm/yyyy)

Marital Status: Current Work Status:
Married Separated Employed
Divorced Deceased Unemployed Pensioner

If Employed, Employer’s Name and Address

………………………………………………………………………………………………………………………………………
………………………………………………………………………………..
Job Title: ……………………………..… Annual Income in GHANA CEDIS: …………………………
INFORMATION ABOUT MOTHER

Full Name: ……………………………………………… Date of Birth:…..…/…..…/…..........(dd/mm/yyyy)

Identity Card / Passport No.: …………………………….……

Place of Issue: ……………………………………… Date of Issue: ………/.……/….......(dd/mm/yyyy)
Marital Status: Current Work Status:
Married Separated Employed
Divorced Deceased Unemployed Pensioner

If Employed, Employer’s Name and Address

………………………………………………………………………………………………………………………………………
………………………………………………………………………………..
Job Title: ……………………………..… Annual Income in GHANA CEDIS: …………………………
INFORMATION ABOUT APPLICANT’S GUARDIAN
Full name:............................................. Date of birth: ......./....../....... (dd/mm/yy)
Marital Status: Current Work Status:
Married Separated Employed
Divorced Deceased Unemployed Pensioner

If employed, Employer” name and Address

.............................................................................................................................................................................................
......................................................................
Job title:................................................ Annual Income in GHANA CEDIS

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SECTION H
High School Honors, Awards and Activities
Please list all your important high school activities, dates of participation, awards, and
offices held (include student representations, sports, school publications, arts, and debate
programs, etc.)

Activity Date Awards Office

________________________ _____________ ______________ ________________
________________________ _____________ ______________ ________________
________________________ _____________ ______________ ________________
________________________ _____________ ______________ ________________
________________________ _____________ ______________ ________________

SECTION I
Personal Essay
On a separate sheet of paper, answer the following essay questions below. Please type the
essay in font sixe 12, with a line spacing of 1.5 and should be a maximum of two pages.
1. Briefly explain why you should be awarded this scholarship.

SECTION I
PRIVACY DECLARATION
The information requested in the application form will be used solely for the purpose of
assessing your application for the scholarship for which you are applying. Personal
information contained in this application will be made available to members of the
Scholarship Committee and staff of the Scholarship office only.

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CHECKLIST (Please tick when you have attached the following documents)
Scholarship application form
A copy of an unconditional admission letter from the University College
The applicant’s Result Slip or Transcript of previous studies
Letters of recommendation from a Teacher, Counselor or Minister of Religion, and
Principal/Vice Principal of a reputable institution
A brief explanation of why you should be awarded this scholarship (250 words maximum)
Two recent Passport pictures (not older than 6 months)
Birth Certificate/Baptismal Certificate/Affidavit

Copy of an Official pay slip or payroll record of parent/guardian or the applicant

Copy of a death certificate or witness by Religious leader
Pensions letter or retired parent/guardians
Copy of School, NHIS, Voter’s or National ID cards
Self-addressed envelope

STUDENT DECLARATION
I ................................................................. declare that all the particulars furnished by me on this application
form are genuine and reflect my true records.

DATE:.................................................... SIGNATURE ……………………………….…

********************************************
Please mail all completed forms along with other required information to:
The Scholarship Coordinator
Pentecost University College
P.O. Box KN 1739 Kaneshie Accra
You may also present it to the Scholarship office directly.

APPLICATIONS RECEIVED AFTER 30TH JULY WILL NOT BE ACCEPTED. AN INCOMPLETE

APPLICATION WILL NOT BE ACCEPTED.
FOR OFFICIAL USE ONLY
RECEIVED

Date:........................... Time................................
Signature....................................................................

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