Bermuda Rhodes Application Form

THE BERMUDA RHODES SCHOLARSHIP 2011

Application Form
(back)

To the Secretary,

SELECTION COMMITTEE FOR BERMUDA.

Sir,

I,	Name of applicant

herewith apply to be regarded as a candidate for THE RHODES SCHOLARSHIP from Bermuda for the year 2010.

I am a British Subject.

My parents (or guardians) resided in Bermuda:

years

from:

to:

The place and date of my birth was:

My age on 1st October, 2011 will be:

years

You must be between 19 years' old and 24 years' old on 1st October, 2011.

My address at my College or University for the forthcoming year is:


	Tel:
Email:	This is important for Scholarship correspondence.

The names and address of my parents (or guardians) in Bermuda is:



Home Tel:	Work Tel:

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

SCHOOL/COLLEGE	CITY/COUNTRY	DATES (from/to)

The list of examinations passed and degrees/diplomas obtained is:

EXAMINATIONS/DEGREES/DIPLOMAS	DATE

My current course of study and expected date of completion is:

COURSE	DATE

The following are the names and addresses of six persons from whom references can be obtained, under at least three of whom I have studied. A copy of the Referee’s Letter has been sent to each of them.

NAME	ADDRESS

ACCOMPANYING THIS APPLICATION ARE

1. A birth certificate (and, where applicable, certificate of Bermudian Status).

2. Certified evidence of the subjects which I have studied, and the examinations which I have passed, including (where applicable) school transcripts, GCSEs/IGCSEs, A levels, IB, and university/college transcripts.

3. A signed statement by myself as to my general interests and activities, the course of study which I propose to follow at Oxford, and the character of the career at which I aim. If the candidate has left school before applying for a Rhodes Scholarship, occupation since leaving should be stated.

4. The Medical Certificate supplied herewith, duly signed by a physician.

5. Four identical studio photographs of myself (unmounted and approximately 10cm by 12cm).

I expect to be available in Bermuda for an interview on Friday, 25th November, 2011 YES / NO

Signed:

Dated:

(A) This application should reach the Secretary of the Selection Committee in Bermuda not later than Friday, 21st October, 2011.

(B) Candidates should already have sent a copy of the Referee’s Letter to each referee. Candidates are asked particularly to ensure that addresses given for referees are those at which they may be reached promptly.

(C) Interviews have been tentatively scheduled for Friday, 25th November, 2011 in Bermuda. You should advise the Secretary as soon as possible if you expect to be unable to attend this date. There is no guarantee that an earlier interview can be arranged.

John C.R. Collis
Secretary of the Rhodes Scholarship Selection Committee for Bermuda
Clarendon House, Church Street
Hamilton HM 11, Bermuda.
Tel: +1 441 299 4910 Fax: +1 441 292 9337 Email: johncollis@jexec.bm
Website: www.rhodes.bm

THE BERMUDA RHODES SCHOLARSHIP 2011

Medical Certificate
(To be supplied by every applicant)

I have examined

Name of Applicant

who is an applicant for a Rhodes Scholarship. From my knowledge of the applicant's history, and as a result of my examination, it is my opinion that the applicant is in good health mentally, emotionally, and physically and has not suffered during the past ten years from any disorder likely to recur and to impair activities as a scholar at Oxford University.

Signed:	Date:
Name:	Address:
Professional Qualifications:

If you should think it necessary to explain or qualify any of the statements in this certificate please add your comments below.

R E M A R K S