Student Bursary Application

STUDENT BURSARY APPLICATION

Use this form to apply for bursary assistance to support tuition, fees, and related educational expenses. Complete all sections fully. Incomplete applications may be declined. All information provided is subject to verification by the bursary committee.

1. Student Information

Student Name:

Date of Birth:    Student ID:

2. Parent / Guardian Information (if applicant is under 18)

3. Bursary Requested

Amount Requested (USD):

Program / Term Start Date:

4. Academic and Enrollment Information

Full-time    Part-time

Have you previously received institutional bursary or scholarship funds?   Yes   No

5. Financial Need and Household Information

6. Supporting Documents Checklist

Official transcript attached
Proof of household income attached (pay stubs, tax notice, letter)
Letter of acceptance or enrollment confirmation attached
Budget/expense statement attached
Other supporting documentation attached

7. Personal Statement

8. Certification, Authorization and Terms

By signing this application I certify that the information contained in this application and any supporting documentation is true, complete, and accurate to the best of my knowledge. I understand that intentionally providing false or misleading information may result in denial of the bursary, recovery of funds already disbursed, and other administrative remedies.

I authorize the bursary committee and its agents to verify the information provided, including contacting educational institutions, employers, and other parties for the purpose of assessment and verification. I understand that personal information collected as part of this application will be used solely for bursary assessment, disbursement, and required record-keeping, and will be retained in accordance with applicable data retention policies.

If awarded, I agree that bursary funds will be applied to eligible educational expenses at the institution named in this application. I understand that continued eligibility may be contingent on academic performance and/or proof of enrollment, and that I must notify the bursary administrator of any change in enrollment status or financial circumstances.

Authorization to disclose: I consent to limited disclosure of my academic records and financial information to the bursary selection committee for the purpose of application assessment.

Certification: I acknowledge the above statements and certify the accuracy of this application.

9. Declaration for Minor Applicants

If the applicant is under 18 years of age, a parent or legal guardian must sign this application and accepts the certification and authorization statements on behalf of the applicant.

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