APPLICATION FOR FINANCIAL ASSISTANCE

Transcription

1 THE UNIVERSITY OF THE WEST INDIES MONA CAMPUS OFFICE OF STUDENT FINANCING APPLICATION FOR FINANCIAL ASSISTANCE INSTRUCTION SHEET Please read the instructions carefully before completing this form and answer all relevant questions. Incomplete applications will not be processed. Completed application forms should be submitted to the Office of Student Financing, UWI Mona Campus. Only Full-Time, registered Undergraduate Students of the Mona Campus are eligible for General Financial Assistance. Please indicate N/A only where the information requested in an item is not applicable to your situation. Where income figures are required, gross amounts must be stated. The Referee s Affidavit must signed, stamped (or sealed) and submitted with all application forms (items ). Kindly note the following persons from whom references may be obtained: - Senior members of the UWI academic staff (e.g. Lecturer) - Student Services' and Development Managers - UWI Counsellors (Health Centre) - Justices of the Peace - Ministers of Religion - High School Principal ** Referee s should know applicant for a minimum of two (2) years. ** Co-curricular transcripts may be obtained from the Office of Student Services and Development. **First Time (1 st Year) Applicants: - A certified letter from your previous school/institution addressed by its Principal, Vice Principal or Guidance Counsellor expressing your financial position.

2 THE UNIVERSITY OF THE WEST INDIES MONA CAMPUS OFFICE OF STUDENT FINANCING APPLICATION FOR FINANCIAL ASSISTANCE TYPES OF ASSISTANCE AVAILABLE FOR REGISTERED FULL-TIME UNDERGRADUATE STUDENTS BOOKS GRANTS MEALS UWI ID #: NAME Title Last Name/Surname First Name Middle Name(s) Reason for Applying Please state how this benefit will assist you? 1

3 THE UNIVERSITY OF THE WEST INDIES MONA CAMPUS OFFICE OF STUDENT FINANCING APPLICATION FOR FINANCIAL ASSISTANCE BIOGRAPHIC PROFILE 1. UWI ID #: 2. TRN : 3. NAME Title Last Name/Surname First Name Middle Name(s) 4. Former NAME (If Applicable) Title Last Name/Surname First Name Middle Name(s) 5. Name Type of Former Name: Maiden [ ] (Prior to) Deed Poll [ ] Other [ ] Please Specify 6. Date of Birth d d / m m / y y y y 7. Sex: Male [ ] Female [ ] 8. Marital Status 9. Country of Birth 10. Nationality 11. Are you a UWI Staff Member? Yes [ ] No [ ] 12. Are you a dependent of a UWI Staff Member? Yes [ ] No [ ] 13. Disability 14. Employment Status 15. Employer 16. Employer s Address 17. Employer s Telephone 18. Employer s Address CONTACT INFORMATION 19. Permanent Address 22. Term/Mailing Address (if you reside on Hall please provide full details) Apt./Street/P.O. Box Apt./Street/P.O. Box City/Town Country Home Phone City/Town Parish Country 20. Address 21. Cellular Phone # 23. Contact #1 24. Contact #2 ACADEMIC PROFILE 25. First Faculty of Admission 26. Present Faculty 27. Programme (B.A., B.Sc. etc.) 28. State your Major/Option 29. Enrolment Status Full Time [ ] Part Time [ ] 30. Level/Year 31. Country of Responsibility 32. Expected Date of Graduation 33. Campus 34. Hall of Residence (Residing) 35. Hall of Residence (Attachment) 2

4 Mother or Stepmother (Omit as necessary) PARENTAL INFORMATION 36. Name 43. Name 37. Address 38. Telephone (W) 45. Telephone (W) 39. Telephone (H) 46. Telephone (H) 40. Occupation 47. Occupation 41. Employer 48. Employer Father or Stepfather (Omit as necessary) 44. Address 42. Salary $ Weekly - [ ] Fortnightly - [ ] Monthly - [ ] Annually - [ ] 49. Salary $ Weekly - [ ] Fortnightly - [ ] Monthly - [ ] Annually - [ ] SPOUSAL INFORMATION APPLICANT S DEPENDENTS 50. Name 58. Name 59. Age 51. Address (If Different from Applicant s Permanent Address) 60. Name of Child s School 61. Name 62. Age 63. Name of Child s School 52. Address 66. Name of Child s School 64. Name 65. Age 53. Telephone (H) 67. Other Dependent Children? Yes [ ] No [ ] 54. Telephone (W) 55. Occupation 56. Employer 57. Salary $ Weekly - [ ] Fortnightly - [ ] Monthly - [ ] Annually - [ ] 68. Have you been awarded a Scholarship/Bursary tenable at UWI Yes [ ] No [ ] 69. If Yes, state name of Award 70. Value $ 71. Co-Curricular Record (On/Off Campus) 72. Work Experience Indicate jobs held within last five years (including vacation employment) Name of Organisation Position Held From To Salary /month dd / mm / yyyy dd / mm / yyyy dd / mm / yyyy dd / mm / yyyy 3

5 BUDGET PLANNER Budget for Academic Year 2016/2017 Expenses ($) Income/Resources ($) 73. Tuition Fees 82. Present Bank Balance 74. Books and Supplies 83. Spouse s Contribution 75. Accommodation 84. Family Contribution Hall of Residence 85. Contribution From Other Sources Off Campus 86. Proceeds From Employment 76. Food 87. Awards (e.g. Scholarships, Bursaries) 77. Clothing Name of Award Value 78. Toiletries a. ($) 79. Transportation b. ($) To and From UWI c. ($) Field Trip 88. Tuition Loans (e.g. SLB etc.) Value 80. Contingencies (Please Specify) a. ($) Item Cost ($) b. ($) a. 89. Grants b. a. ($) c. b. ($) d. 90. Other Income/Resources 81. Total Expenses =================== 91. Total Income/Resources ================ 92. Shortfall (Subtract Total Expenses from Total Income) 93. I confirm that the information provided in this application is correct and acknowledge that any incorrect information provided will be grounds for the application to be rejected. I further give consent for all information to be verified without further consent from me: Applicant s Signature Date (DD/MM/YYYY) Assessment Committee s Decision 4

6 REFEREE S AFFIDAVIT 94. REFEREE S NAME Last Name/Surname First Name Middle Initial(s) 95. Referee s Address 96. Telephone (H) 97. Telephone (W) 98. Address 99. Occupation 100. Name of Employer/Business 101. Name of STUDENT being recommended 102. How long have you known him/her? Year(s) Month(s) 103. What do you know of the applicant s family? 104. What do you know about the co-curricular activities of the applicant? 105. To your knowledge, is this person experiencing financial difficulties? Yes [ ] No [ ] 106. If yes please explain: 107. Would you regard the student as someone with integrity? Yes [ ] No [ ] 108. If yes please explain: 109. How would assistance from this office benefit the student? 110. Is there any other pertinent information that you think we should know? Yes [ ] No [ ] 111. If yes please explain: 112. I hereby declare that the information provided above and by the applicant is to the best of my knowledge true. Signed Date d d / m m / y y y y N.B. - Referees must know the applicant for at least two (2) years and should be able to attest to the information provided by the applicant. - All Referees must affix the official stamp of their office / department / organization. - Justices of the Peace (JP s) must affix their official seal provided by the Government. 5