Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697705721247.pdf (Dominica)
GOVERNMENT OF THE COMMONWEALTH OF DOMINICA MINISTRY OF EDUCATION AND HUMAN RESOURCE DEVELOPMENT APPLICATION FORM TERTIARY EDUCATION ASSISTANCE PROGRAM: 40% STUDENT LOAN DEBT RELIEF Complete ALL Items below.

Do not leave ANY items blank.

IDENTIFICATION TYPE Passport sized photo Passport ________________________________ Driver’s License ________________________________ Social Security ________________________________ APPLICANT BASIC INFORMATION Mr. Miss.
Ms. Mrs. Name:__________________________________________________________________ (Print in Blocks) First Middle Surname Address: _________________________________________ Nationality: _________________ _________________________________________ Date of Birth: _____/______/______ (dd) (mm) (yy) Home Phone: _________________ Mobile: __________________ E-mail: ______________________ EDUCATION DETAILS Degree Major/Field of Study:___________ ________________________________________ Level of Study: ASc BSc Masters Doctoral Post Graduate License Registered Nurse Other Post- Secondary Certification _____________________________________________________ Name & Location of Educational Institution: (Details) _____________________________________________________________________________________ Mode of Study: Full time Part-time On-campus Online External/Distance 1 GOVERNMENT OF THE COMMONWEALTH OF DOMINICA MINISTRY OF EDUCATION AND HUMAN RESOURCE DEVELOPMENT START DATE OF STUDY DATE OF COMPLETION OF STUDY _____/_____/______ (dd) (mm) (yy) WORK HISTORY _____/_____/_____ (dd) (mm) (yy) EMPLOYED: YES NO SELF EMPLOYED: YES NO Name/Location/Contact of Employer: Name & Contact of Reference Person: _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Commencement Date of Current Employment: _____/_____ /______ If Unemployed, Date of Last Employment: LOAN DETAILS: (dd) (mm) (yy) _____/_____/_____ (dd) (mm) (yy) Lending institution at which loan was obtained:______________________________________________ Date Loan was Contracted: _____/______/______ (dd) (mm) (yy) Details of Loan:  Amortization Period: _______________________ (No.
of years)  Monthly Repayment Amount: ______________________  Outstanding Principal Balance as at October 31, 2018: ______________________ I hereby certify that to the best of my knowledge, all of the information furnished in this application is complete and accurate.

Signature ________________________ Date_____________________ Application Check List 1.

Passport sized photo 2.

Completed application form 3.

Copy of graduation certificate (certified) 4.

Status letter from the financial institution 5.


Other supporting documentation 6.

Letter of employment 7.

Self-employed persons, please provide 8.

Identification document reference letter 2