UWC School and College Nomination Form

UWC School and College Nomination Form

Please note that on receipt of this nomination form the information will be handled in

accordance with the data protection laws of the country in which the school or college is

located.

NOMINATION FORM CONTENTS

Section 1: Main Information

Section 2: Personal Nominee Information

Section 3: Nominee Background

Section 4: Parent(s) / Guardian(s) Contact Information

Section 5: Parent(s) / Guardian(s) Employment Information

Section 6: Parent(s) / Guardian(s) Dependants Information

Section 7: Parent(s) / Guardian(s) Financial Assets Information

Documentation

Checklist

Section 1: Main Information

The following information must be entered exactly as it appears on the nominee's national

passport on which they will be travelling. Please check this information carefully before

submitting this form.

1) UWC school / college (which UWC school / college is the nomination for?):

______

2) Nominee (full name): ______

3) Nominated by:

National committee / Selection contact: Japan National Committee

NC contact person: Tomoko Hasegawa

NC contact email :

NC contact telephone number: +81-3-6741-0163

Section 2: Personal Nominee Information

The following information must be entered exactly as it appears on the nominee's national

passport on which they will be travelling. Please check this information carefully before

submitting this form.

4) Nominee name (as appears on passport):

Family name / Last name: ______

First name / Given name(s): ______

Middle name (if applicable): ______

5) Nominee preferred name:______

6) Gender identity:______

7) Gender (biological sex) as stated on passport, if different to previous answer.

______

8) Date of birth (mm/dd/yy):______

9) Country of birth:______

10) Nationality (if nominee has more than one passport, please provide details

below):

______

11) Country of citizenship:______

12) Contact information:

Email address: ______

Home phone (include country code): ______

Cell phone (include country code): ______

Fax: ______

13) Permanent home address:

Address line 1: ______

Address line 2: ______

City: ______

Province: ______

Post code / Zip code: ______

Country: ______

Section 3: Nominee Background

14) What is the student’s level of English:

Complete beginner / Beginner (conversational level) / Intermediate / Advanced / Fluent,

Native speaker

______

15) Did student raise in their application any difficulties (please specify and

comment)?

No / Mental health difficulties / Physical difficulties / Learning difficulties / Other (please

specify)

______

16) Why you are recommending this student for nomination (this can be down to the

characteristics you look for during the selection process or any other specific reasons you

would like to point out).

______

Section 4: Parent(s) / Guardian(s) Contact Information

Please include the information for both parents / guardians where appropriate.

17) Parent / Guardian One:

Relationship to applicant: ______

Family name / Last name: ______

First name / Given name: ______

Email address: ______

Home phone (include country code): ______

Cell phone (include country code): ______

Fax: ______

18) Parent / Guardian One permanent home address:

Address line 1: ______

Address line 2: ______

City: ______

Province: ______

Post code / Zip code: ______

Country: ______

19) Parent / Guardian Two:

Relationship to applicant: ______

Family name / Last name: ______

First name / Given name: ______

Email address: ______

Home phone (include country code): ______

Cell phone (include country code): ______

Fax: ______

20) Parent / Guardian Two permanent home address:

Address line 1: ______

Address line 2: ______

City: ______

Province: ______

Post code / Zip code: ______

Country: ______

Section 5: Parent(s) / Guardian(s) Employment Information

Sections 5, 6 and 7 only need to be completed in the following circumstances:

● The family is applying for financial assistance which matches the offer made to your

national committee

● The college requires a financial assessment irrespective of the level of funding given.

Please check the requirements with the college

21) Parent / Guardian One:

Present occupation: ______

Current salary (annual) and currency: ______

Name of company / Employer: ______

Length of time with employer: ______

22) Parent / Guardian Two:

Present occupation: ______

Current salary (annual) and currency: ______

Name of company / Employer: ______

Length of time with employer: ______

Section 6: Parent(s) / Guardian(s) Dependants Information

Sections 5, 6 and 7 only need to be completed in the following circumstances:

● The family is applying for financial assistance which matches the offer made to your

national committee

● The college requires a financial assessment irrespective of the level of funding given.

Please check the requirements with the college

Please complete this for all family's dependants.

23) Dependant One:

Relationship to applicant: ______

Name: ______

Age: ______

Daily living costs in US$: ______

Name of school / College attending (if applicable, also specify if public or private school): ______

Monthly Living Costs (include education costs):______

Who pays for this currently? ______

24) Dependant Two:

Relationship to applicant: ______

Name: ______

Age: ______

Daily living costs in US$: ______

Name of school / College attending (if applicable, also specify if public or private school): ______

Monthly Living Costs (include education costs): ______

Who pays for this currently? ______

25) Dependant Three:

Relationship to applicant: ______

Name: ______

Age: ______

Daily living costs in US$: ______

Name of school / College attending (if applicable, also specify if public or private school): ______

Monthly Living Costs (include education costs): ______

Who pays for this currently? ______

26) Any other dependants?

______

27) Does the student have any dependants? If so, please provide the details as for

above (name / age / daily living costs, etc.)

______

Section 7: Parent(s) / Guardian(s) Financial Assets Information

Sections 5, 6 and 7 only need to be completed in the following circumstances:

● The family is applying for financial assistance which matches the offer made to your

national committee

● The college requires a financial assessment irrespective of the level of funding given.

Please check the requirements with the college

28) Currency:

Local Currency: ______

Exchange rate to US$: ______

Date of exchange rate: ______

29) Nominee’s current accommodation? (Indicate the answer with x):

House / Apartment / Bungalow / Other (please specify)

______

30) Accommodation ownership: (Indicate the answer with x):

Family owned / Rent / Government provided / Other (please specify)

______

31) Total number of bedrooms in the household:

______

32) Parent / Guardian One (indicate if stated before or after tax) in US$:

Professional income (per month): ______

Income from pension (per month): ______

Income from investments (per month): ______

Income from property (per month): ______

Land & property: ______

Any other income, please specify (per month): ______

33) Parent / Guardian Two (indicate if stated before or after tax) in US$:

Professional income (per month): ______

Income from pension (per month): ______

Income from investments (per month): ______

Income from property (per month): ______

Land & property: ______

Any other income, please specify (per month): ______

34) Total monthly household income: ______

34a) Any other assets: ______

35) Details of your family’s monthly expenses in US$:

House Rent / Mortgage: ______

Telephone Bills: ______

Utility Bills: ______

Food & Household Expenditure: ______

Transport Costs: ______

Medical bills: ______

Other (please specify): ______

36) Are any of these subsidised by government? Please provide details:

______

37) Amount you can contribute annually:

______

Documentation

Documentation must be provided to verify income and asset information requested on this

form.

Which of the following documents will you be attaching? (Indicate the answer with x

and provide the files):

Tax forms / Pay slips / Statement from employer / Bank statement / Other (please specify)

______

Checklist

Please ensure these are in the requested language if applicable. Please note it is the

responsibility of the national committee to ensure the nomination is complete and check the

specific requirements of the college.

Have you included each of the following?(Indicate the answer with x and provide the

files):

Copy of passport / Schools transcripts (check if they are required in English) / Application

(usually required in English) / References / Other documentation requested by the school /

college / Other (please specify)

______

Thank you for completing the nomination form! The declaration form is below. If you have any questions, please contact us at

Declaration

Please check the fees document HEREfor the full costs of the two year place at UWC as

the fees differ between the schools and colleges. If you are still unsure please also check

with the UWC school or college the student is attending.

The published fees do not include pocket money, transportation or health/travel insurance. If these additional expenses are also covered the applicant will be notified by the UWC.

Extra costs: This may include travel, pocket money and project week (please note if school/college is indicated as covering costs this must have been agreed with them in advance and will most likely be based on a financial assessment).

Please check with the UWC what extra costs you are expected to pay as the costs can be

significant.

The signatures of the parent(s)/guardian(s) certify that the financial information is accurately completed and that they agree to pay the stated amounts to the UWC school or college that their son/daughter/ward is attending. The school or college will review this financial information and agree the final fee contributions with you and the family based on this information. The financial information must be typed into this nomination AND a copy signed by the parents must also be uploaded, it is the responsibility of the NC to check all of the information is included.

Failure to make these payments will result in the school or college taking action in

accordance with their own policies. Please ensure the family is clear on this before you

upload their signed agreement.

Entry 2018 (Jan 2019 for WK)

Update August 2019

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