Rhodes application

THE RHODES SCHOLARSHIPS
APPLICATION FORM
2012

To the Secretary, Committee of Selection, Rhodes Scholarships
21 East Street, Kingston, Jamaica, West Indies.

Sir,

I............................ (full name ) herewith apply to be regarded as a candidate for the Rhodes Scholarship for the year 2012, I am a citizen of .......................................

My Parents (or guardian) resided in ...................................... for ........................... years while I was between the ages of .............................. The date and place of my birth was...............................................................................................

My Parents' names, address, occupation and telephone numbers are as follows:

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

I was at the following Schools and Colleges/Universities for the periods named:-

A Birth certificate
"O" level, "A" level, CAPE or CXC certification or other certified evidence of the subjects which I have studied, and the examinations which I have passed
A signed statement by myself (of maximum 1,500 words or two (2) A4 pages, Times New Roman, 12pt.) as to my general interest and activities, the course of study which I propose to follow at Oxford, and the character of the work at which I aim in later-life.
Particulars of the following 6 persons, under at least 4 of whom I have recently studied (with mail addresses, telephone, fax & email address) who will provide letters of reference.

(1)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

(2)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

(3)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

(4)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

(5)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

(6)...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

My home/permanent address is:

My correspondence address (if different):

Effective date for correspondence address:

My telephone # for immediate contact is:

(..........).......................................

My fax # is:

(..........).......................................

My primary e-mail adrress is:

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

My primary e-mail adrress is:

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

My secondary e-mail adrress is:

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

(By signing this form, I consent to the release of this information to the Selection Committee, staff of Rhodes House & relevant staff & officers of the University of Oxford).

Signed:...................................................