SHE-CAN Application Questions – Cambodia
Note this is NOT an official application form. This document is a resource to help you prepare your responses to the questions in the form before submission. To submit your SHE-CAN application, visit http://shecan.global/become-a-scholar/, and click on the appropriate application link.
First (Given) Name:
Last (Family) Name:
Email:
Phone:
Mailing Address/PO Box:
Address Where You Currently Live:
Country of Citizenship:
Primary Language Spoken at Home:
Age:
Birthdate (DD/MM/YY):
Birth City:
Which option below best describes where you grew up?
o Rural (in a village or the countryside)
o Suburban (directly outside of a city)
o Urban (in a city)
Please describe where, when and how often you are on the internet. Please tell us if you have access at home, and if not, where you access it. Tell us if you use your phone and/or computer to access the internet. (700 character limit)
Do you own a computer? If not, does someone in your family have a computer that you can access? (700 character limit)
High School Attending/Graduated From:
Date of Graduation from High School (or Expected Date of Graduation):
Secondary School Class Rank (What number were you academically in class: 1st, 2nd, 5th, 23rd, 55th?) If your school does not have ranks, please put "NA."
(File upload only) Please upload your transcripts from grades 10, 11 and 12. If they are not in English, please provide an official or personally translated version along with the original. **We cannot consider your application or invite you to an interview without seeing your grades.** If not available, please upload a text document explaining why and when you expect to receive copies of them.
If you have taken the National Exam, please tell us your percentile rank and grade. (e.g. 97.632 B):
(File upload only) If you have taken the National Exam, please upload your National Exam Results. **Without a record of your National Exam Score we cannot invite you to an interview. ** If not available, please upload a text document explaining why and when you expect to receive a copy of your score.
Are you currently enrolled in or have you graduated from a college or university? If yes, please provide the school name, the year you are in (first, second, etc), and your major.
(File upload only) If you attend a college or university, please upload transcripts/grades from each semester you have completed. **Without your grades we cannot invite you to an interview.**
If you have taken any of the exams listed below, please indicate which exams you have taken. (You can select more than one by checking multiple boxes.)
o ACT exam
o SAT exam
o IELTS exam
o TOEFL exam
o I have not taken any of these exams
If you have taken any of the exams listed above, please tell us the composite score you received and the year that you took the exam for each of the exams. (e.g. I took the ACT in 2015 and my score was 24)
(File upload only) If you have taken any of the exams listed above, please upload copies of your scores.
Primary Caretaker's Name (What is the name of the person responsible for you?):
Primary Caretaker's Email Address:
Primary Caretaker's Phone Number:
Primary Caretaker's Relationship to you (Is this person your mother, father, brother, uncle, adoptive mother, adoptive father, other?)
Secondary Caretaker's Email Address:
Secondary Caretaker's Phone Number:
Secondary Caretaker's Relationship to you (Is this person your mother, father, brother, uncle, adoptive mother, adoptive father, other?)
Your Household: Please list everyone in your household and their relationship to you. (e.g. Sam - Father, Lisa - Mother, Sarah - Sister, Daniel - Brother, Ellen - Grandmother) (1,400 character limit)
How many people live in your current household AND are monetarily supported 50% or more by your primary and/or secondary caretakers?
Which of the following does your family own:
o Refrigerator
o Television
o Automobile
o Motorbike
o Computer
o Internet in your home
o None of these
Family Income and Jobs: Please list every member of your household whose income contributes to your support and describe in detail: 1) the job they have, meaning their role or job title 2) the name of the company or place they work and 3) details about the type of work they do to earn the money that supports you. Must answer all 3 questions for each person and be specific! (2,000 character limit)
Please estimate your monthly household income. How much does each member of your household earn every month? If their income is inconsistent or seasonal (like farming or tourism), please explain here. (1,400 character limit)
Please tell us which best represents your household's total yearly income.
o 1,000,000 riel or less
o 2,000,000 to 4,000,000 riel
o 4,000,000 to 8,000,000 riel
o 8,000,000 to 15,000,000 riel
o 15,000,000 to 20,000,000 riel
o 20,000,000 riel or more
How much money could your parents or family members contribute to pay for your college education each year?
Please describe your home. How many rooms does it have? How many bedrooms? How many bathrooms? Do you have your own room or share? How many people sleep in your room? Do you have electricity? How many lights do you have? (2,000 character limit)
Tell us about you and what makes you unique, your family background, and any challenges you or your family may have faced. Share any details about your life and how you’ve grown into the person you are. (2,4000 character limit)
Career Goals: What are your current career goals? Tell us about an area of study or type of career you are interested in right now. What about that field interests you? What experiences have you had or steps have you taken to prepare and learn about that type of career? (1,400 character limit)
Activities: Please tell us about all of the activities that you have participated in and briefly describe how they relate to your passions and interests. What clubs, organizations, sports, school activities, etc. were or are you involved in and what leadership roles did you play? (1,400 character limit)
Scholarships: What other scholarships are you applying for or being considered for? Please list and explain all schools, scholarship opportunities, or scholarship programs you have applied for, been accepted into, or plan to apply for. (Pursuing multiple opportunities will not hurt your chances of being accepted by SHE-CAN, but not disclosing your intentions may affect your eligibility.) (1,400 character limit)
What are the titles of your favorite books, movies, and/or television shows and why? (1,400 character limit)
Imagine that you are in the same class as your best friend and you sit next to each other on the day of a big test. You notice that your friend is cheating by looking at another student's test. What would you do? Would you take action? If so, what steps would you take? If not, why not? (2,400 character limit)
How did you hear about SHE-CAN? What organization or person(s) suggested you apply? (500 character limit)
Please select all the types of people you personally know who are involved with SHE-CAN. It is important that you disclose all acquaintances regardless of how well you know them, and not disclosing these relationships could affect your eligibility for the program.
o SHE-CAN Scholar
o SHE-CAN Mentor
o SHE-CAN Volunteer
o SHE-CAN Teacher
o SHE-CAN Employee
o Other
o I don’t know any SHE-CAN people.
If you indicated that you personally know someone involved with SHE-CAN, please tell us who you know by name and also tell us your relationship to them (friend, family member, etc.)
Do you have any questions or issues with this application you need us to know about? Please explain here. (2,000 character limit)