The VM GSAT “HEAD-START” Bursary is a one-time bursary offered to students who have completed GSAT in the year of application and will be starting secondary education.

SPECIAL INSTRUCTIONS: BEFORE COMPLETING THIS FORM, PLEASE READ THE REGULATIONS.

Each candidate should complete one copy of this form. This form does not require any supporting documents. The application form should be returned to the nearest Branch of The Victoria Mutual Building Society (VMBS).

Applications for the 2018 VM “Head- Start” Scholarship Programme open on Monday, March 19, 2018 and close Friday, July 13, 2018.

Student’s Name .......................................... / ....................................................... / .............................................. First Middle Initial Surname

Parent’s Name: .......................................... / ....................................................... / .............................................. First Middle Initial Surname

Date of Birth ......................................................... Sex: Male Female

Nationality ..............................................................

Home Address: ........................................................................................................................................................

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

Mailing Address (if different from home address)................................................................................................

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

Email Address:...........................................................................................................................................................

Parent’s Telephone Number: (h)..................................(w)....................................... ( C).......................................

Name of past school:................................................................................................................................................

Name of new school:.................................................................................................................................................

VMBS Account Number:...........................................................................................................................................

All applicants should be the holder of an active VMBS Savings Account (the account must not be dormant).

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

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REGULATIONS GOVERNING THE GRANTING OF THE VM GSAT BURSARY

Each Bursary candidate (child) must:

1. Be an active VMBS saver (that is, savings account should not be dormant). The child’s name must be on the VMBS account listed.

2. Sit the Grade Six Achievement Test (GSAT) in the year of applying.

3. Have completed the VM GSAT Bursary Application Form and submitted it to a VMBS Branch on or before the closing date.

4. Not be a recipient of any other Scholarship/s or bursaries for the given year.

Only candidates who have been awarded a place in a high school will be eligible for this scholarship. The

applicant with the highest GSAT Score in the specific school as confirmed by the ministry of education

will receive a one-time bursary valued at JA$20,000.00.

VM GSAT “HEAD-START”BURSARY AUTHORISATION & CERTIFICATION

In accepting the VM GSAT “Head-Start” Bursary , I, ________________________________________

_____________, being the father/mother/legal guardian of ___________________________________

_____________ , who is under 18 years old, hereby grant and assign to Victoria Mutual Building Society

(“VMBS”) forever and throughout the world, the irrevocable, non-exclusive right to use his/her name, voice,

photograph, images or likeness for any promotional, commercial, advertising, or other purpose as VMBS

may desire, in all media, whether now known or hereafter devised, throughout the world in perpetuity

(including, without limitation, in any print media or publications, on the Internet, on basic cable, free and

pay television systems worldwide and all supplemental market uses, video cassette, DVD and/or video

disc), and in all forms (including, without limitation digitised images), without further compensation or

any limitation whatsoever, unless prohibited by law.

If any selected VM GSAT Bursary recipient cannot be contacted he/she will forfeit the VM GSAT Bursary and VM will select an alternate recipient. I, _______________________________________________,

hereby certify that I am the father/mother/legal guardian of __________________________________

_______, and I have read and fully understood the above terms and conditions and I accept them. In

addition, the information, which has been given to the above questions, is true and complete. I understand

that any misrepresentation could lead to his/her disqualification as a candidate for this VM GSAT Bursary.

______________________________ ______________________ ____________________ Signature of Applicant’s Witness Date Parent or Legal Guardian

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