Credit Union

SECTION A : APPLICANT’S PERSONAL DATA

* Must Be Field

1. *TITLE : MR MRS

2.* SURNAME

3.*FIRST NAME

4.* MIDDLE NAME(S)

5. *DATE OF BIRTH

6. *GENDER

MALE FEMALE

7.* ADDRESS

8. MAILING ADDRESS (If different from 7.)

9.* TELEPHONE CONTACT:

(H)
(W)
(C)

10. *MARITAL STATUS

SINGLE
MARRIED
SEPARATED
DIVORCE
WIDOWED
COHABILITATING

11. WHICH TYPE OF COURSE DO YOU WISH TO PURSUE?

UNDER-GRADUATE
POST-GRADUATE DIPLOMA
MASTER’S DEGREE (MSc, MBA, MPhil)
DOCTORATE (PhD)

12. CATEGORY OF APPLICANT

Candidate dependant on parents/legal guardian
Candidate dependant on spouse
Independent Mature Candidate

13. TICK WHICH CATEGORY BEST DESCRIBES YOU?

EMPLOYED (P/T)
UNEMPLOYED
EMPLOYED (F/T)
STUDENT OTHER (Please specify)
LIVING WITH PARENT(S)/LEGAL GUARDIAN
LIVING WITH SPOUSE/PARTNER
LIVING ALONE

SECTION B : APPLICANT’S EMPLOYMENT AND ACADEMIC HISTORY

14. EMPLOYMENT HISTORY

NAME OF EMPLOYER	OCCUPATION	PERIOD OF EMPLOYMENT

15. ACADEMIC HISTORYY

NAME OF INSTITUTION	PERIOD OF ATTENDANCE	SUBJECT/GRADES

16. HAVE YOU EVER APPLIED FOR A STUDENT GRANT AT ANY OTHER INSTITUTION?

YES NO

IF YES, PLEASE SPECIFY (NAME OF INSTITUTION, DATE, IF SUCCESSFUL/UNSUCCESSFUL)

17. DO YOU HOLD OR HAVE YOU EVER HELD A STUDENT GRANT?

YES NO

IF YES, PLEASE SEPCIFY (NAME OF INSTITUTION, DATE, LENGTH OF TIME)

SECTION C : PERSONAL DETAILS OF APPLICANT’S PARENT(S), LEGAL GUARDIAN, DEPENDANTS, SPOUSE OR PARTNER

18. *MOTHER’S FULL NAME

ADDRESS(Optional)

*TELEPHONE CONTACT:

(H)
(W)
(C)

OCCUPATION (If applicable)

19. *FATHER’S FULL NAME

ADDRESS(Optional)

*TELEPHONE CONTACT:

(H)
(W)
(C)

OCCUPATION (If applicable)

20.FULL NAME OF SPOUSE/PARTNER

ADDRESS

TELEPHONE CONTACT:

(H)
(W)
(C)

OCCUPATION (If applicable)

21. DEPENDANT(S) IF ANY

NAME OF INSTITUTION	AGE	SCHOOL

(Please note that Dependants are person in the applicant’s household who are: a. sixteen (16) years and under; b. over sixteen (16) years and in full-time education or; c. medically certified as unfit for work)

SECTION D: APPLICANT’S INCOME AND EXPENDITURE

22. Are you presently in receipt of any government assistance grants or insurance payments?

YES NO

If yes, please specify and give amount:

23. PLEASE LIST PRESENT EXPENDITURE IN THE FOLLOWING CATEGORIES (TO THE CLOSEST APPROXIMATE VALUE):

YES NO

If yes, please specify and give amount:

24. DO YOU RECEIVE INCOME FROM ANY OTHER SOURCES (RENTAL OF PROPERTY,SELF-SUSTAINED BUSINESS, INCOME FROM INVESTMENTS, LUMPSIM PAYMENTS FROM A SETTLEMENT, GIFTS OF INHERITANCE)

FOOD
UTILITIES:
RENT
CLOTHING
PERSONAL ITEMS
OTHER (PLEASE SPECIFY):

25. IN ESSAY FORMAT, PLEASE GIVE VALID REASONS WHY YOU SHOULD BE CONSIDERED FOR THE HIGHER LEVEL EDUCATION GRANT:

26. ANY ADDITIONAL INFORMATION

DECLARATION

I DO DECLARE THAT THE AFOREMENTIONED INFORMATION, ALONG WITH SUPPORTING DOCUMENTS, IS TRUE AND CORRECT.

I UNDERSTAND THAT THE CONTACT INFORMATION GIVEN WOULD BE USED SOLEY TO MAKE FURTHER CONTACT WITH ME REGARDING THE STATUS OF MY APPLICATION

I ACKNOWLEDGE THAT IF ANY GIVEN INFORMATION IS PROVEN TO BE INCORRECT OR UNTRUE, MY APPLICATION WOULD BE REJECTED.

FULL NAME OF APPLICANT
SIGNATURE OF APPLICANT:
DATE OF APPLICATION

FOR OFFICIAL USE ONLY

SHAREHOLDER’S ACCOUNT NUMBER
AMOUNT IN SHARES
AMOUNT IN DEPOSITS
OUTSTANDING LOANS (IF ANY)
LOAN REPAYMENT STATUS	Excellent Good Fair Poor Very Poor

RECOMMENDED
NOT RECOMMENDED

TRANSCORP CREDIT UNION CO-OPERATIVE SOCIETY LIMITED HIGHER EDUCATION GRANT APPLICATION FORM

SECTION A : APPLICANT’S PERSONAL DATA

SECTION B : APPLICANT’S EMPLOYMENT AND ACADEMIC HISTORY

SECTION C : PERSONAL DETAILS OF APPLICANT’S PARENT(S), LEGAL GUARDIAN, DEPENDANTS, SPOUSE OR PARTNER

SECTION D: APPLICANT’S INCOME AND EXPENDITURE

DECLARATION

FOR OFFICIAL USE ONLY