test form

Section 1. Applicants’ Biographical Data
General Info
Applicant's First Name*
Applicant's Father's Name*
Applicant's Grandfather's Name*
Date of Birth (E.C.)*
Sex*
- Male
- Female
Any Visual/Hearing/Mobility Impairment?*
- Yes
- No
Country of Citizenship by Birth*
- Ethiopian
- Non-Ethiopian
Where did you take EHEECE?*
- Amhara National Regional State
- Other Places in Ethiopia
Home Address
Region*
Zone*
Woreda*
Sub-city*
Kebele/Gotè*
House Number*
Contact Information
Phone Number*
Email Address*
Secondary Email Address
Emergency Contact
Full Name*
Tel/Mobile Number*
Kebele/Gotè*

Section 3. Applicants' Tertiary Education Information
Intended Undergraduate Study Program
Please rank each study program in order of preference.
Preference 1*
Preference 2*
Preference 3*
Preference 4*
Preference 5*
Preference 6*
Preference 7*
Preference 8*
Preference 9*
Preference 10*
Preference 11*
Preference 12*
Note: Ministry of Education's rules of admission limits shifts between study streams chosen at preparatory level.

Section 5. Voluntarism, Leadership and Future Aspirations
Leadership Positions Held
Position Roles and Responsibilities Contact Person
Community Service/Voluntary Work Done
Position Roles and Responsibilities Contact Person
Achievements/Awards/Honours
Achievement/Award/Honour Description Contact Person

Section 6. Motivation, Aspiration and Giveback
Essay Question 1*
What is your vision for your local community? How would this scholarship help you attain this vision? Are you willing to return back to your community and work to the betterment of conditions for the disadvantaged? (200 words maximum)
Essay Question 2*
Describe a community service project that you think is interesting and has the potential to bring desirable changes. If you have been directly involved, provide details of your role and level of involvement. If you haven’t been involved, but have seen the project in action, what qualities do those involved hold that you feel make them effective? (150 words maximum)
Essay Question 3*
Write an essay on the problems and challenges of people with disabilities in Ethiopia and describe your role and strategies in dealing with these problems or challenges (150 words maximum).

Section 7. Attachments
Reference Letters*
Please include your reference letters. See below for links to download the necessary forms.
Drop files here or
Referees Forms (English)
Referees Forms (Amharic)
Email
This field is for validation purposes and should be left unchanged.

Section 1. Applicants’ Biographical Data

Position	Roles and Responsibilities	Contact Person

Position	Roles and Responsibilities	Contact Person

Achievement/Award/Honour	Description	Contact Person