Application For Student Bursary Scheme 2022

APPLICATION FOR STUDENT BURSARY SCHEME
This form is also available on the USP website: www.usp.ac.fj/forms
STUDENT BURSARY APPLICATION CHECKLIST

Please ensure that you have provided all the requirements stated in this checklist before submitting this form.
Completed all sections in the Student Bursary Scheme Application form.

TIN Letter of Applicant, and or Parent(s)/ Guardian(s) if supporting applicant. Spouse’s TIN Letter if married.
Evidence of family income (latest Salary Slip).
If not working or self-employed, please provide a valid Statutory Declaration as proof of family income.
(Statutory Declaration is a written statement affirming that something is true to the best knowledge of the Declarant; in the presence of a
Solicitor, Justice of Peace, or Notary Public. The Statutory Declaration form can be obtained from a Lawyer or a Justice of Peace).
Applicant’s recent bank statement or a letter from the bank confirming your account details.
TSLS Confirmation of ineligibility (For Fiji Students in undergraduate programme)
Recent Progress Report endorsed by the Faculty Research Committee [For Continuing Research students]
SECTION A: PERSONAL DETAILS

Student ID Number: Campus: Year/ Semester:
Full Name: (As it appears on your Birth Certificate)

Date of Birth Citizenship:
Marital Status: Number of Children : Sex : Female Male

(Attach childrens birth certificate)

Personal Email: Telephone :
Programme

If your parents or siblings are also studying at USP this semester, state their Student ID numbers here:
SECTION B: APPLICANT’S BANK DETAILS (For refund purposes)
Account Name : Bank Account Number: Bank:

SECTION C: WHO PAYS YOUR FEES?

Please place a tick in the appropriate box below:
a) Self-funding. Must show evidence of income and amount. (Please complete Section D)
b) Supported by parents/ guardian or spouse (Please complete Section E and F)
c) Partly Self-funding and partly supported by parents/guardian/ spouse (Please complete section D, E, and F)
SECTION D: EMPLOYMENT DETAILS OF APPLICANT
Certified to be True by Employer:

Name of Employer (if Employed):
Occupation:
Signature and Official Stamp of Employer
required in this section
Telephone: Your Gross Annual Income $
SECTION E: FINANCIAL DETAILS OF SPOUSE
Full Name of Spouse: Sex : Female Male
Date of Birth : Age : Citizenship
Postal Address:
Telephone: Email :
Name of Employer Occupation:

(if Employed):
Employers Telephone contact
SECTION F: FINANCIAL DETAILS OF PARENTS/ GUARDIAN

FATHER’s Details MOTHER’s Details
Father’s Full Name: Mother’s Full Name:
Date of Birth: Date of Birth:

DD MM YYYY DD MM YYYY
Place of Birth : Age: Place of Birth : Age:
Postal Address: Postal Address:
Telephone: Telephone:
Email: Email:
Employment Details: Employment Details:
Name of Employer (if Employed) : Name of Employer (if Employed) :
Occupation : Occupation :
Telephone: Annual Gross Income $ Telephone: Annual Gross Income $
Certified to be True by Employer: Certified to be True by Employer:
Signature and Official Stamp of Employer Signature and Official Stamp of Employer
required in this section required in this section
GUARDIAN’s Details Guardian’s Employment Details:
Guardian’s Full Name: Name of Employer (if Employed) :
Date of Birth: Occupation :

DD MM YYYY
Place of Birth : Age: Telephone: Annual Gross Income $
Postal Address: Certified to be True by Employer:
Telephone:
Signature and Official Stamp of Employer

Email: required in this section
SECTION G: DECLARATION
I _____________________________________, the applicant, do solemnly and sincerely declare that the information provided
in this application is complete and accurate to the best of my knowledge. I acknowledge that USP reserves the right to cancel
assistance if information is deemed incomplete / invalid or if l withdraw from courses for the assisted academic term.
Note: There are penalities for deliberately Submitting false or misleading information.
Applicant’s Signature: Date:
(Please check if you have accurately filled this form. Incomplete forms will not be assessed)
FOR OFFICIAL USE

1. Vetting
1.1 Application vetted: Complete Incomplete HOLD

Comments:
1.2 Registration: New resuming Student Continuing Student Registered Non-registered
1.3 Applicant’s GPA Grades for previous semester:
Vetted by: Date:

2. Financial Details
Applicant’s Income : $ Total Gross Annual Income:
Spouse’s Income : $ $
Father’s Income : $
(A Sum of Section C and D)
Mother’s Income : $
Guardian’s Income : $
3. Decision: Recommend Do Not Approved
Notes by Authorised officer:
Recommending officer: Date:
WHERE TO SEND YOUR COMPLETED APPLICATION
Via EMAIL : scholarships@usp.ac.fj

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APPLICATION FOR STUDENT BURSARY SCHEME

This form is also available on the USP website: www.usp.ac.fj/forms

STUDENT BURSARY APPLICATION CHECKLIST

Completed all sections in the Student Bursary Scheme Application form.

SECTION A: PERSONAL DETAILS

Full Name: (As it appears on your Birth Certificate)

Marital Status: Number of Children : Sex : Female Male

SECTION B: APPLICANT’S BANK DETAILS (For refund purposes)

Account Name : Bank Account Number: Bank:

SECTION C: WHO PAYS YOUR FEES?

b) Supported by parents/ guardian or spouse (Please complete Section E and F)

SECTION D: EMPLOYMENT DETAILS OF APPLICANT

Certified to be True by Employer:

Full Name of Spouse: Sex : Female Male

Date of Birth : Age : Citizenship

Name of Employer Occupation:

SECTION F: FINANCIAL DETAILS OF PARENTS/ GUARDIAN

Father’s Full Name: Mother’s Full Name:

Date of Birth: Date of Birth:

Place of Birth : Age: Place of Birth : Age:

Postal Address: Postal Address:

Employment Details: Employment Details:

Name of Employer (if Employed) : Name of Employer (if Employed) :

Telephone: Annual Gross Income $ Telephone: Annual Gross Income $

Certified to be True by Employer: Certified to be True by Employer:

Guardian’s Full Name: Name of Employer (if Employed) :

Date of Birth: Occupation :

Place of Birth : Age: Telephone: Annual Gross Income $

Postal Address: Certified to be True by Employer:

Signature and Official Stamp of Employer

Applicant’s Signature: Date:

FOR OFFICIAL USE

1.2 Registration: New resuming Student Continuing Student Registered Non-registered

1.3 Applicant’s GPA Grades for previous semester:

Vetted by: Date:

Applicant’s Income : $ Total Gross Annual Income:

3. Decision: Recommend Do Not Approved

Notes by Authorised officer:

Recommending officer: Date:

WHERE TO SEND YOUR COMPLETED APPLICATION

Via EMAIL : scholarships@usp.ac.fj

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