Scholarship - Agatha Jn Panel

Scholarship Application Form (Agatha Jn Panel Award)
Account Number:
Date:
Please return completed forms by September 8.
Name of Parents:
Laborie Co-operative Credit Union Ltd.
Allan Louisy Street, Laborie
and Clarke Street, Vieux Fort
St. Lucia
Phone: 1 (758) 459-6900 | 1 (758) 459-6930
Fax: 1 (758) 455-9289 | 1 (758) 454-6069
www.mylaboriecu.com
Address of Parents:
Home Phone:
Cell Phone:
Name of Student:
Address of student:
Gender:
Male
Female
Scholarship Criteria
Date of Birth:
School Attended:
CXC Scores: Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Subject:
Grade:
Tertiary Institution Assigned:
Total Household Income:
No. of Income Earners:
Number of dependents:
Number of Pensioners:
No. of Children Attending:
2.
The awardee must have
gained entry to Sir Arthur Lewis
Community College or Post
Secondary Division/ A' Level of
the Vieux Fort Comprehensive
Secondary School.
Primary School
Secondary School
Tertiary Institution
Sporting Discipline:
I hereby warrant and confirm that the foregoing statements are true and correct and have been made by me
knowing that you will place reliance on them when considering my application. You are hereby authorized to
obtain any information you may require relating to this application from any source which you may apply and
each such source is hereby authorized to provide you with such information.
_______________________________________
Signature of Parent / Guardian
Submit by E-mail
Print Form
[email protected]
For Official Use Only
Status of Account:
In Good Standing
Delinquent
1.
This award is based on
the member's general Socioeconomic situation and level of
participation in the business and
other activities of the Credit
Union.
Dormant
3.
The Award is valued at
$1500.00 annually.
4.
The applicant (awardee|
awardee's parent/ guardian) must
have been a member of the
Society for at least one year prior
to gaining entry to Sir Arthur
Lewis Community College or
Post Secondary Division/ A'
Level of the Vieux Fort
Comprehensive
Secondary
School.
Comments of Reviewer: ________________________________________________________
5.
The applicant (awardee|
____________________________________________________________________________ awardee's parent/guardian) must
not have any delinquent loans at
Committee's Decision:
Granted
Not Granted
the time of the application.
Hilary Darcheville
Laura Collymore
Comments:
6.
The awardee must be a
citizen of St. Lucia.
____________________________________________________________________________
7.
The awardee must be
____________________________________________________________________________ under 25 years old.
Signature of Committee Members:
____________________________________________________________________________

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