SCHOLARSHIP APPLICATION

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Personal Details

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

SCHOOL INFORMATION

Name of Current School:

School’s Telephone Number:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Extra-Curricular Activities:

REQUIRED DOCUMENTS

Please upload certified copies of past term reports from the Grade 6 academic year

Click or drag files to this area to upload. You can upload up to 2 files.

Allowed file type, docx, pdf

Please upload your PEP results here

Click or drag files to this area to upload. You can upload up to 2 files.

Allowed file type, docx, pdf

Please upload your Reference

Click or drag files to this area to upload. You can upload up to 2 files.

At least one (1) reference- Principal, Pastor, Justice of the Pease or Superintendent of Police

Please submit a 3-5 min video on why you should be selected

Click or drag a file to this area to upload.

PARENT/GUARDIAN’S INFORMATION

Parent/Guardian’s Name

First

Last

Parent/Guardian’s Contact Number

Parent/Guardian’s Contact Number #2

Parent/Guardian’s Occupation

Parent/Guardian’s Email

Confirm Email

Are you a current employee of Bert’s Auto Parts?

Your Signature

Date Signed

Personal Details

SCHOOL INFORMATION

REQUIRED DOCUMENTS

PARENT/GUARDIAN’S INFORMATION

good luck

with your application with your application