INSTRUCTIONS Please read the terms and conditions below before filling out this form. All fields with * are mandatory Available to final year undergraduate applicants pursuing a government sponsored programme in Science, Technology, Engineering, Mathematics (STEM) at The University of the West Indies or The University of Technology, Jamaica. BIOGRAPHICAL INFORMATION First Name* Middle Name Surname* ID No.* Gender*MaleFemale Place Of Birth* Date Of Birth* Nationality* JamaicaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCanadaCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Home Address* Address while on campus* Mobile Country Code* Jamaica + 1-876Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263 Mobile Number* 10 Mobile Country Code Jamaica + 1-876Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263 Home Number 10 Email* Confirm Email* First Name of parent or guardian* Last Name of parent of guardian* Email* Confirm Email* Mobile Country Code* Jamaica + 1-876Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263 Mobile Number* 10 Mobile Country Code Jamaica + 1-876Afghanistan + 93Albania + 355Algeria + 213American Samoa + 1-684Andorra + 376Angola + 244Anguilla + 1-264Antarctica + 672Antigua and Barbuda 1-268Argentina + 54Armenia + 374Aruba + 297Australia + 61Austria + 43Azerbaijan + 994Bahamas + 1-242Bahrain + 973Bangladesh + 880Barbados + 1-246Belarus + 375Belgium + 32Belize + 501Benin + 229Bermuda + 1-441Bhutan + 975Bolivia + 591Bosnia and Herzegovina + 387Botswana + 267Brazil + 55British Indian Ocean Territory + 246British Virgin Islands + 1-284Brunei + 673Bulgaria + 359Burkina Faso + 226Burundi + 257Cambodia + 855Cameroon + 237Canada + 1Cape Verde + 238Cayman Islands + 1-345Central African Republic + 236Chad + 235Chile + 56China + 86Christmas Island + 61Cocos Islands + 61Colombia + 57Comoros + 269Cook Islands + 682Costa Rica + 506Croatia + 385Cuba + 53Curacao + 599Cyprus + 357Czech Republic + 420Democratic Republic of the Congo + 243Denmark + 45Djibouti + 253Dominica + 1-767Dominican Republic + 1-809East Timor + 670Ecuador + 593Egypt + 20El Salvador + 503Equatorial Guinea + 240Eritrea + 291Estonia + 372Ethiopia + 251Falkland Islands + 500Faroe Islands + 298Fiji + 679Finland + 358France + 33French Polynesia + 689Gabon + 241Gambia + 220Georgia + 995Germany + 49Ghana + 233Gibraltar + 350Greece + 30Greenland + 299Grenada + 1-473Guam + 1-671Guatemala + 502Guernsey + 44-1481Guinea + 224Guinea-Bissau + 245Guyana + 592Haiti + 509Honduras + 504Hong Kong + 852Hungary + 36Iceland + 354India + 91Indonesia + 62Iran + 98Iraq + 964Ireland + 353Isle of Man + 44-1624Israel + 972Italy + 39Ivory Coast + 225Jamaica + 1-876Japan + 81Jersey + 44-1534Jordan + 962Kazakhstan + 7Kenya + 254Kiribati + 686Kosovo + 383Kuwait + 965Kyrgyzstan + 996Laos + 856Latvia + 371Lebanon + 961Lesotho + 266Liberia + 231Libya + 218Liechtenstein + 423Lithuania + 370Luxembourg + 352Macau + 853Macedonia + 389Madagascar + 261Malawi + 265Malaysia + 60Maldives + 960Mali + 223Malta + 356Marshall Islands + 692Mauritania + 222Mauritius + 230Mayotte + 262Mexico + 52Micronesia + 691Moldova + 373Monaco + 377Mongolia + 976Montenegro + 382Montserrat + 1-664Morocco + 212Mozambique + 258Myanmar + 95Namibia + 264Nauru + 674Nepal + 977Netherlands + 31Netherlands Antilles + 599New Caledonia + 687New Zealand + 64Nicaragua + 505Niger + 227Nigeria + 234Niue + 683North Korea + 850Northern Mariana Islands + 1-670Norway + 47Oman + 968Pakistan + 92Palau + 680Palestine + 970Panama + 507Papua New Guinea + 675Paraguay + 595Peru + 51Philippines + 63Pitcairn + 64Poland + 48Portugal + 351Puerto Rico + 1-787Qatar + 974Republic of the Congo + 242Reunion + 262Romania + 40Russia + 7Rwanda + 250Saint Barthelemy + 590Saint Helena + 290Saint Kitts and Nevis + 1-869Saint Lucia + 1-758Saint Martin + 590Saint Pierre and Miquelon + 508Saint Vincent and the Grenadines + 1-784Samoa + 685San Marino + 378Sao Tome and Principe + 239Saudi Arabia + 966Senegal + 221Serbia + 381Seychelles + 248Sierra Leone + 232Singapore + 65Sint Maarten + 1-721Slovakia + 421Slovenia + 386Solomon Islands + 677Somalia + 252South Africa + 27South Korea + 82South Sudan + 211Spain + 34Sri Lanka + 94Sudan + 249Suriname + 597Svalbard and Jan Mayen + 47Swaziland + 268Sweden + 46Switzerland + 41Syria + 963Taiwan + 886Tajikistan + 992Tanzania + 255Thailand + 66Togo + 228Tokelau + 690Tonga + 676Trinidad and Tobago + 1-868Tunisia + 216Turkey + 90Turkmenistan + 993Turks and Caicos Islands + 1-649Tuvalu + 688U.S. Virgin Islands + 1-340Uganda + 256Ukraine + 380United Arab Emirates + 971United Kingdom + 44United States + 1Uruguay + 598Uzbekistan + 998Vanuatu + 678Vatican + 379Venezuela + 58Vietnam + 84Wallis and Futuna + 681Western Sahara + 212Yemen + 967Zambia + 260Zimbabwe + 263 Home Number 10 Occupation* EDUCATIONAL BACKGROUND Schools attended (Period of attendance) * Name of Present School * Course of Study at University* Expected year of University graduation* Profession/Occupation Candidate has in mind* Distinctions gained or positions of responsibilities held during your educational career. State extra curricular activities :- FUNDING How are you presently covering the cost of tuition and other expenses? :Student LoanBoarding GrantParental SupportOther If other, please state If you applied for a student's loan, has it been approved? :YesNoPending If you have not applied for a student loan, why not? State reasons: Supporting Documents Upload the following documents using the required formats(Max: 5MB. Allowed per file: pdf|doc|docx|zip|rar])* Statement of career goals* Copy of your birth certificate* Academic Records* (Provide copies of your CSEC, CAPE and University grades - 1st to final year) Letter of Recommendation* (From a current lecturer/tutor)