THE UNIVERSITY OF THE WEST INDIES

MONA CAMPUS

GUILD OF STUDENTS
FINANCIAL ASSISTANCE PROGRAMME (G.F.A.P)

INSTRUCTION SHEET

Please read the instructions carefully before completing

this form and answer all relevant questions.

There are 123 sections for the applicant to fill out.

Incomplete applications will not be processed.

Please indicate N/A where the information requested in

an item is not applicable to your situation.

Completed application forms should be emailed to:

[email protected] with the applicants name as
the Subject of the email and the Referees Affidavit
and SSDMs Endorsement should be submitted in
HARD COPY to:

MONA The Office of the Guild of

Students, Students Union;

WJC - R300 (3rd Floor, above the Main

Office)

Applicants should not be current recipients of any award

or other financial assistance (towards university
education) where the value or combined value exceeds
Eighty Thousand Jamaican Dollars ($80,000.00 JMD)

Where income figures are required, gross amounts must

be stated.

Only applications supported by the relevant Student

Services and Development Managers (SSDMs) or
Resident Advisers (RAs) will be considered for
assistance.

The Referees Affidavit MUST be submitted in HARD

COPY in a sealed envelope, with the required stamp
affixed to the document for applications to be processed.
References may be obtained from the following persons:

Senior member of the Academic Staff (e.g.

Lecturer)

Applicants must be a Registered Student in an

Undergraduate Programme at the UWI, Mona Campus

Applicants must have an outstanding balance owed to

the University.

Applicants should not be employed in a full-time job.

Student Services' Managers or Senior Resident

Advisor

UWI Counsellors (Health Centre)

Justices of the Peace
Ministers of Religion

The deadline for submission of Application Forms for Friday September 28, 2012.

APPLICATION FOR GUILDS FINANCIAL ASSISTANCE PROGRAMME

BIOGRAPHIC PROFILE
1. UWI ID #
2. NAME

Title

3. Former
NAME
(If Applicable)

Last Name/Surname

Title

Last Name/Surname

First Name

Middle Name(s)

First Name

Middle Name(s)

4. Name Type of Former Name: Maiden [ ] (Prior to) Deed Poll [ ] Other [ ] Please Specify ___________________________
5. Date of Birth

6. Sex: Male [ ]

dd / mm / yyyy

8. Country of Birth

Female [ ]

7. Marital Status

9. Nationality

10. Are you a UWI Staff Member?

Yes [ ]

12. Disability

No [ ]

11. Are you a dependent of a UWI Staff Member? Yes [ ] No [ ]

13. Employment Status

14. Employer

15. Employers Address

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
16. Employers
Telephone _________________________________

17. Employers
E-mail Address

____________________________________

CONTACT INFORMATION
18. Permanent Address

21. Term/Mailing Address (if you reside on Hall please provide full details)

Apt./Street/P.O. Box__________________________________

Apt./Street/P.O. Box____________________________________

___________________________________________________

_____________________________________________________

___________________________________________________
City/Town
19. Home Phone

Parish

Country
20. Cellular Phone

_____________________________________________________
City/Town
22. Contact Phone

Parish

Country

23. E-mail Address

ACADEMIC PROFILE
24. First Faculty of Admission 25. Present Faculty
28. Enrolment Status

29. Level

32. Campus (Mona/ WJC)

26. Programme (B.A., B.Sc., L.L.B., etc.)

27. State your Major/Option

30. Country of Responsibility

31. Expected Date of Graduation

33. Hall of Residence (Residing)

354 Hall Attachment

PARENTAL INFORMATION
Mother or Stepmother (Omit as necessary)
35. Name

Father or Stepfather (Omit as necessary)

42. Name

36. Address______________________________

43. Address______________________________

_____________________________________
_____________________________________

_____________________________________
_____________________________________

37. Telephone (W)

44. Telephone (W)

38. Telephone (H)

45. Telephone (H)

39. Occupation

46. Occupation

40. Employer

47. Employer

41. Salary $_____________________

48. Salary $_____________________

Weekly - [ ]

Weekly - [ ] Fortnightly - [ ] Monthly - [ ] Annually - [ ]

Fortnightly - [ ]

Monthly - [ ] Annually - [ ]

SPOUSAL INFORMATION

DEPENDENT CHILDREN

49. Name

57. Name

50. Address (If Different from Applicants Permanent Address)

59. Name of Childs School

________________________________
________________________________
________________________________

63. Name

51. E-mail Address

65. Name of Childs School

52. Telephone (H)

66. Other Dependent Children? Yes [ ]

60. Name

58. Age

61. Age

62. Name of Childs School

64. Age

No [ ]

53. Telephone (W)

54. Occupation
55. Employer
56. Salary $_____________________
Weekly - [ ] Fortnightly - [ ] Monthly - [ ] Annually - [ ]

BUDGET PLANNER
67. Budget for Academic Year ________/________

Expenses ($)

Income/Resources ($)

68. Tuition Fees

________________________

77. Present Bank Balance

__________________

69. Books and Supplies

________________________

78. Spouses Contribution

__________________

79. Family Contribution

__________________

70. Accommodation
Hall of Residence

________________________

80. Contribution From Other Sources

__________________

Off Campus

________________________

81. Proceeds From Employment

__________________

71. Food

________________________

82. Awards (e.g. Scholarships, Bursaries)

72. Clothing

________________________

Name of Award

Value

73. Toiletries

________________________

a. _______________________________

($) ______________

b. _______________________________

($) ______________

74. Transportation
To and From UWI

________________________

c. _______________________________

($) ______________

Field Trip

________________________

83. Tuition Loans (e.g. SLB etc.)

Value

a. _______________________________

($) ______________

b. _______________________________

($) ______________

75. Contingencies (Please Specify)

Item

Cost ($)

a. ______________________

______________________

84. Grants

b. ______________________

______________________

a. _______________________________

($) ______________

c. ______________________

______________________

b. _______________________________

($) ______________

d. ______________________

______________________

85. Other Income/Resources

76. Total Expenses

================

__________________

86. Total Income/Resources

================

87. Shortfall (Subtract Total Expenses from Total Income)

88. I affirm that the information provided within this form is correct:
___________________________
Applicants Signature

________________________
Date (dd/mm/yyyy)

TYPE OF ASSISTANCE
89. Please state below, the preferred area(s) of assistance from the MOST TO LEAST IMPORTANT
a. School Fees

b. Food and Toiletries

c. Books

d. Transportation (please see the routes traversed by the Guilds bus service)

____________________________________________________________________________________________________________
__________________________________________________________________________________________________________
90. Have you applied for transfer to another Faculty/Campus in the upcoming academic year? Yes [ ]
91. If yes to Ques. 90 state name of:

92. Faculty

No [ ]

93 Campus

94. Have you been awarded a Scholarship/Bursary tenable at UWI Yes [ ] No [ ]

95. If Yes, state name of Award ___________________________________________________ 96. Value $____________________

97. 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
dd / mm / yyyy dd / mm / yyyy
dd / mm / yyyy dd / mm / yyyy
98. Career Objective
State your career goals, and the contribution you think you will be able to make towards the development
of your country:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________________

REFEREES AFFIDAVIT
99. NAME

Last Name/Surname

First Name

Middle Initial(s)

100. Home Address

____________________________________________________________________________________________
____________________________________________________________________________________________
______________________________________________________________________________________
101. Telephone (H)

102. Telephone (W)

104. Occupation

103. E-mail Address

105. Name of Employer/Business

106. Name of student being recommended

107. How long have you known him/her?

Year(s)

Month(s)

108. What do you know of the applicants family?

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
109. What do you know about the co-curricular activities of the applicant?
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
110. Is this person experiencing financial difficulties?Yes [ ] No [ ]
111. If yes please explain:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
112. Would you regard the student as someone with integrity?
Yes [ ] No [ ]
113. If yes please explain:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
114. How would assistance from the Guild benefit the student?

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
114. Is there any other pertinent information that you think we should know?
Yes [ ] No [ ]
116. If yes please explain:______________________________________________________________________________________
____________________________________________________________________________________________________________
117. I hereby declare that the information provided above and by the applicant is to the best of my knowledge true.
Signed_______________________________________________
N.B.

Date

dd / mm / yyyy

- 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.

118. Academic distinctions and/or prizes received:

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____________________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________

____________________________________________ ____________________________________________
119. State benefits to be gained from your successful training:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
120. State reason(s) for applying which may include, but not restricted, to financial circumstances:

_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
121. PREVIOUS ASSISTANCE RECEIVED FROM THE GUILD (IF APPLICABLE)
DONOR

YEAR

AMOUNT ($)

122. STUDENT COMMITMENT

The Guild Council is committed to assisting students, as best possible, by effectively engaging all the resources it has at
its disposal. All students who receive assistance through this program are now required to participate in at least one Guildled activity (at the Hall, Faculty or Executive level). This is to facilitate greater involvement in the business of the Council
and ensure that you make the most of the opportunities for student development afforded thereby. By signing below you
agree to this requirement.
I ______________________________ agree to participate in at least one Guild-led activity, with the exception of
Integration Thursdays, (at the Hall, Faculty or Executive level) and attend one Guild General Meeting for this Semester.
Signed: ________________________________________
ID number: ____________________________________

Date: ________________________________________

123. Student Services & Development Managers Endorsement (SUBMIT IN HARD COPY)
I ___________________________, hereby endorse the application of ________________________________
(SSDM /Nominee)

(Student)

(hereafter Applicant) for the Guilds Financial Assistance Programme. I endorse the Applicant because:

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
______________________________________________________________________
Signed: ______________________________________

Date: ______________

(SSDM/Nominee)

For Official Use Only

Documents Submitted

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________________________________

Assessment Committees Decision

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