AFFIX ENDORSED

BARCLAYS TERTIARY SCHOLARSHIP UNIVERSITY OF PROFESSIONAL STUDIES, ACCRA (FINANCIAL AID UNIT)

PASSPORT SIZE PHOTOGRAPH

UNDERGRADUATE APPLICATION FORM 2017/2018 ACADEMIC YEAR (CONTINUING STUDENTS ONLY) NOTE: DEADLINE FOR SUBMISSION OF APPLICATION FORM: 22ND SEPTEMBER 2017 PLEASE NOTE THAT YOUR APPLICATION WILL NOT BE PROCESSED IF YOU LEAVE ANY QUESTION UNANSWERED (ONLY SHORTLISTED APPLICANTS WILL BE CONTACTED)

SECTION A – APPLICANTS PERSONAL INFORMATION STUDENT ID.......................................... 1. Full name, as it appears on your documents with the University Surname:

Other Name(s):

2. Date of Birth

Place of Birth:

Region

3. Home Town

Region

4. Gender (Female/Male)

Nationality

5. School Term Address:(where you live when school is in session. Provide details on your hall of residence, hostel, rented accommodation, or home address if you will be living at home)

6. Mobile telephone#:

Email Address

7. Academic Programme of Study (e.g. Bachelor of Business Administration, Bachelor of Science, etc,)

1



8. Level of Study for 2017/2018 academic year

9. CGPA



10.EDUCATIONAL HISTORY Full Name of School

Dates of Attendance (eg 2012-2015)

Who was responsible for your educational expenses and upkeep at this level?

SHS Technical /Vocationa l Institute Other (specify)

SECTION B 1– INFORMATION ON FINANCES

11. Estimated Expenses for the 2017/2018 academic year. (Estimate how much you will need to spend during the academic year from August 2017 to May 2018. These expenses should be relevant to your studies only. Academic Fees (University Approved Fees and Charges) Use this year’s amount.

GH¢

Residential /Housing/ Hostel (for 1st and 2nd semester)

GH¢

st

Feeding (for 1 and 2

nd

semester)

GH¢

Books

GH¢

Transportation

GH¢

Other (specify)

GH¢

Other (specify)

GH¢

TOTAL GH¢ 12. Indicate below the amount of money that you expect will be available to you from each of the following sources for 2017/2018 academic year. Personal

GH¢

Parents/ Guardian

GH¢

Benefactor

GH¢

Part-time employment

GH¢

SSNIT / SLTF students loan

GH¢

Scholarship (specify)

GH¢

Other (specify)

GH¢

Other (specify)

GH¢

TOTAL GH¢

2



13. How much funding do you require? This amount is the difference between your total estimated expenses (question 11 and what you expect will be available to you from the sources indicated in question 12. GH¢

SECTION B 2 – INFORMATION ON SPONSORSHIP 14. If you have applied or intended to apply for other types of financial support for the 2017/2018 year please complete the table below. The type of financial support (e.g. Scholarship, bursary, students loan) a.

Amount

The agency to which application has been, or, will be made(e.g Students Loan Trust Fund)

(GH¢)

b.

15. If you have been promised financial support for the 2017/2018 academic year from any Body/Organization, Benefactor, or Individual please complete the table below. Name and address of the Body/Organization/Benefactor/Individual

The amount in financial support (GH¢)

a.

b.

SECTION B 3 - FOR STUDENTS WITH DISABILITIES 16a. Do you qualify to receive Government b. Type of Disability (if known)? Bursary for disability? c. How much in scholarship do you expect to receive? GH¢___________________



3





17. SECTION B 4 - APPLICANT’S EMPLOYMENT HISTORY (IF APPLICABLE) a. PERIOD OF EMPLOYMENT. b. NAME, ADDRESS AND CONTACT INFORMATION OF CURRENT OR LAST EMPLOYER

c. WILL YOU BE ON SALARY DURING THE PERIOD OF YOUR STUDIES?

SECTION B 6 - ADDITIONAL INFORMATION 18. You may provide additional information to support this application.

SECTION B7 – ESSAY 19. State in not more than 300 words why you should be considered for this scholarship, your academic and career goals, and the relevance of your programme of study to the socio-economic prospects of your country (Ghana (submit this on a separate sheet). Please attach the following documents to your application (do not send the originals of any documents: • • • • • •

Up-to-date academic transcript Evidence of income of parent/guardian. Applicant’s most current pay slip if applicable. Documents/evidence to establish the relationship with siblings and or dependants as the case may be. (Birth certificate etc.) Sworn affidavits to support any claims made on this application form. Provide two references, at least one from your Faculty

Any other supporting documents that you believe will assist in the processing of your application. Declaration It is important that your eligibility for this Scholarship be based upon accurate information. I do hereby declare that to the best of my knowledge, all the information given above is true. Signature of Student

Date

Note: Misrepresentation in any material form renders the application null and void. Any award made based on misrepresentation shall be withdrawn or refunded by the applicant.

4





SECTION C 1 - (TO BE COMPLETED BY PARENT/LEGAL GUARDIAN – person so far responsible for financing the education of the applicant)

20a.. Full Name of guardian/parent Surname:

b.Address.

Other Name(s): Telephone #

c.

Occupation. 21.Annual Total Gross Income.(GH¢)

(Salary and income from other sources. Please substantiate with a recent official salary slip, pension slip. If unemployed, please attach some form of evidence and declare your sources of funds). Please note that this information is necessary and if not provided the FAU will disqualify your application. Other income that you receive from any of the under listed sources: Pension : Investment returns : Rental income: Contribution from others sources : Earnings from taxi, passenger cars, corn mill, farming activities, petty trading, remittances from family etc). : 22. What is your relationship to the applicant? Father Mother Uncle Aunt Brother Sister Other (Specify) 23. Accommodation that you and your family occupy. Own House Family House Rented Premises paid for by my employer Rented premises paid for by self Other (specify)

5





24. Provide Information on your dependants. First Name(s)

Surname

Relationship

Age

Educational Level

25. Indicate total amount paid in fees and other related expenses per year for dependants at each level of education and provide proof of current attendance (Attach school bills and receipts):

Level of Education

Number of dependants of school going age

Total Amount Paid per year (GH¢)

Kindergarten/Primary JHS SHS/Tech-Vocational. Tertiary Other TOTAL

26. How much are you prepared to pay towards the fees and upkeep of your ward for the 2017/18 academic year? GH¢

SECTION C 2 - TO BE COMPLETED BY YOUR SECOND PARENT/GUARDIAN

(One who supports your main first parent(20a) 27a.Full Name Surname:

c.

b. Address.

Other Name(s)

Telephone # Name and address of employer.(Where applicable)

Occupation.

27. Annual Total Gross Income (Salary and income from other sources) (GH¢).

6





28. What is your relationship to the applicant Father Mother Other



DECLARATION TO BE SIGNED BY BOTH PARENTS OR GUARDIAN It is important that your dependant’s eligibility for student financial aid be based upon accurate information. I do hereby declare that all the information given above is true. Signature or thump print of parent/guardian

Date

Signature or thump print of second parent

Date

Note: Misrepresentation in any form or manner shall render the application null and void. Any awards made based on a misrepresentation shall be withdrawn or refunded by the applicant The University reserves the right to cancel the applicant’s application if false or incorrect information is supplied. FOR OFFICE USE ONLY …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… ……………………………………………………………………………………………………………





7