Applicants Statement Form Dec 2015

The Education for
Sustainable Energy
Development
Scholarship

PLEASE TYPE CLEARLY

Applicant's Statement Form (p. 1 of 2)
1

Family name

First name

Middle name(s)

Place of birth

Date of birth (YYYY-MM-DD)

Citizenship

Male
E-Mail

Phone Number

✔ Female

Please provide brief answers to all of the following questions within the
limits provided. The total must be 2 pages maximum.

2

How is your program of choice related to sustainable energy development?

3

Why do you want to study in this sustainable energy development program? If your program has various
modules, please indicate and describe the module you will take.

4

In what ways are your qualifications outstanding?

Applicant's Statement Form (p. 2 of 2)

5

6

7

What kind of volunteer activities related to sustainable energy development have you performed in your school, work, or
community? List each of your experiences in point form.

Upon return to your country at the end of your studies, in what specific activities related to sustainable energy will you wish to
be involved in to benefit your country and/or community?

Indicate your commitment to return to your country

□

YES ✔

8

NO

□

Your signature confirms the accuracy of the information provided in this application form. Typing your name on the line
below will be considered a signature.

Signature of Student

Date (YYYY-MM-DD)