EDUCATION AND SCHOLARSHIP PROGRAMME

O. B. LULU-BRIGGS FOUNDATION GRANT AWARD

APPLICANT BIO-DATA SHEET
1.APPLICANT NAME(LAST,FIRST,MIDDLE) / 2.GENDER / 3.STATE OF ORIGIN
5.TELEPHONE/MOBILE NUMBER / 6.L.G.A
4.APPLICANT ADDRESS
7.EMAIL / 8.NATIONALITY
9.PLACE OF BIRTH
10.EDUCATION
(Include all college and university degrees)
NAME AND LOCATION OF INSTITUTION / MAJOR / DEGREE / C.G.P.A / YEAR OF GRADUATION
11.CERTIFICATION
Applicant certifies that in submitting this form, he /she has taken necessary steps to ensure the authenticity of the information contained in this form and understands that O. B . Lulu-Briggs Foundation will ascertain the veracity of these information. Applicant understands that the provision of false, fictitious, or fraudulent information may result in appropriate remedial action by the O. B. Lulu-Briggs Foundation which may include disqualification and termination of the Grant.
Signature of Applicant / Date
INSTRUCTIONS Applicants are advised to study the form carefully before completing it, as names on this form must correspond with names in submitted certificates and other related documents. Resit students are not eligible to apply/fill out this form. Only students of Rivers State Origin that meet the eligibility criteria should apply. All forms are to be submitted not later than 30 April 2017.

O. B. LULU-BRIGGS

FOUNDATION

Education & Scholarship Programme –Nigerian Law School Grant

2016-17 academic year

Note to the Applicant: All applications received will be considered by the O. B. Lulu-Briggs Foundation’s Scholarship Board. However, incomplete applications or any application received after the stipulated date will not be considered.

Applicants are required to:

  • Meet the eligibility requirements/criteria as outlined in the notice to intending grantees online.
  • Complete and submit a copy of this application form.
  • Law School Admission Letter
  • Local Government Identification Certificate
  • 2 recent passport photographs
  • Law school Identity card
  • LLB degree certificate/Statement of result/Transcript (Student copy)

A. BIO-DATA

Surname:

Other names:

Gender: Male Female (please tick the appropriate box)

Are you living with disability? Yes No

Place of Birth:

State of Origin: L.G. A :

Home Town: Compound:

Mobile Phone:

Email:

Residential Address:

B. Parent or Guardian Details

Surname:

Other names:

Relationship to Student:

Mobile phone:

Email address:

Occupation/Designation:

Office Address:

Residential address:

C. EDUCATION (List the names of all the institution attended and degree/qualifications obtained with dates, starting from the most recent qualification)

1.

2.

3.

4.

D. Grant Application

1) If awarded the Grant, how would it help you in achieving academic excellence during the pendency of your law school admission?

2) List any awards, achievements or activities that you have been involved in such as academic, sporting, music, and/ or any contributions that you have made to your school/community.

3) In other to strengthen /improve the grant award process, are you willing to fill out our impact assessment form and speak with our monitoring and evaluation representative when contacted?

E ) Referee Details

Kindly provide details for two referees from work or school. (family member not allowed)

Referee 1

Name (surname first):

Position or Title:………………………………………Organization………………………………….

Office/BusinessAddress:…………………………………………………………………………………………………………………………………………………………………………………………………..

Relationship to Applicant:…………………………………………………………………………………

If the Scholarship Board needs further information regarding the applicant, indicate preferred contact

Office/Business Mobile Phone Number:…………………………………..

Home Mobile Phone Number…………………………………...

Email: Email Address:…………………………………………….

Referee 2

Name (surname first):

Position or Title:………………………………………Organization……………………………………

Office/BusinessAddress:…………………………………………………………………………………………………………………………………………………………………………………………………..

Relationship to Applicant:…………………………………………………………………………………

If the Scholarship Board needs further information regarding the applicant, indicate preferred contact

Office/Business Mobile Phone Number:…………………………………..

Home Mobile Phone Number…………………………………...

Email: Email Address:…………………………………………….

E) Terms and Conditions

NB: The ‘Applicant’ herein expressly refers to the grantee, whilst ‘ OBLF’ refers to the O. B. Lulu-Briggs Foundation.

  1. The OBLF reserves the right to seek additional verification of applicants’ submission.
  2. Reserves the right to cancel or suspend a grant award if it is discovered that the information provided by an applicant/grantee were misleading or false.

F) Authorized declaration by Applicant

I declare that the information submitted in this application for the Grant Award of the O. B. Lulu-Briggs Foundation is true and correct.

I authorize the OBLF to make appropriate enquiries in regard to my application, such as reference checking and validation of the application.

I acknowledge that the submission of any incorrect or misleading information to the OBLF may result in termination of the Grant Award.

I understand that the decision of the Scholarship Board regarding the Grant Award is final and is subject to the Terms and Conditions as stated in this application form.

If you agree to the above declaration please tick this box.

Name of authorized declarant/Applicant:………………………………………………………………….

Date: DD/MM/YY……………………

Signature:………………………

O. B. Lulu-Briggs Foundation –Nigerian Law School Grant Award