Application Form

General Information

Title (check one): ☐ Mr. ☐ Mrs. ☐ Miss	Sex: ☐ Male ☐ Female

First Name: Click here to enter text.	Middle Name: Click here to enter text.	Surname: Click here to enter text.

Nationality: Click here to enter text.	Date of Birth: Click here to enter a date.	Student ID#: Click here to enter text.

Home Address: Click here to enter text.

E-mail: Click here to enter text.

Telephone: Click here to enter text.	Fax: Click here to enter text.

Faculty: Click here to enter text.	Major: Click here to enter text.

Year: Click here to enter text.	Level: Click here to enter text.	Campus: Choose an item.

YOUR ACHIEVEMENTS

State Academic Distinctions and/or prizes received:

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Please provide a detailed statement of your co-curricular activities on campus:

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State the position(s) or responsibility that you have held:

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YOUR ASPIRATIONS FOR JOINING UWI STAT

State reasons for applying:

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State benefits to be gained from your successful selection/representation:

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YOUR GOALS

State your career goals & the contribution you think you can to make towards the development of:

Your Country:

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UWI:

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Caribbean:

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YOUR ACTIVITIES

Are you involved in any community service projects/sporting activities?

Sports:

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Culture:

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Outreach:

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ABOUT YOU

Do you have any special skills? If so, please list them below:

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Do you have any special talents that would make you more attractive to the Corps? If so, please list:

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Please provide a brief description of yourself:

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What is your preferred medium of communication?

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Application Checklist

☐ Completed Application	☐ Resume Attached	☐ Recommendation Attached

________________________	_________________________	________________________

Signature	Witness	Date