Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697629861763.pdf (Antigua and Barbuda)
Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 Please attach a recent photo of you.

INSTRUCTIONS: 2 0 1 7 A P P L I C A T I O N F O R M Each candidate must complete one (1) copy of this form either electronically, typewritten or hand written legibly in BLUE OR BLACK ink.

Please note this form should be accompanied by a receipt for $50.00 paid to Eastern Caribbean Amalgamated Bank (ECAB) into account 102000818.
All sections of this form must be completed in full and submitted no later than April 27 2017 by 12:00 noon.

The following documents must be submitted with each application form.

DOCUMENTS: i.

Recent Passport-sized photo (to be attached to the form in the space provided) ii.

Certified copy of photo page and date of expiration page of Passport iii.

Certified copy of your birth certificate iv.


A certified copy of academic certificate/diploma/ degree v. A letter of acceptance from the Institution to which you have applied (Applicants may submit the completed application form without the acceptance letter to ensure he/she meets the deadline of April 27 2017 However, the acceptance letter from the University must be submitted by July 28 2017 If already in the Institution, progress report or transcript must be supplied) vi.
Statement from applicant and parent (guardian) regarding other sources of funding vii.

Rationale for granting of the National Student Loan fund (No more than 200 words) viii.

Detailed breakdown of cost of study from University ix.

Passport and job letter of Surety Please Note the Following: • In preparing your rationale, please outline your plan of Study stating particularly how your training will allow you to contribute to the development of Antigua and Barbuda.
In addition, please give your reasons for choosing this course of study.

(Use a separate sheet).

• The statement regarding funding sources must clearly outline plans to supplement any loan amount received from the NSLF.

Documentation, including bank statement, supporting this plan should also be provided.

Please note that there is no guarantee that the amount requested will be the actual loan amount granted.

(Use a separate sheet).

A.


GENERAL INFORMATION: 1. a) Name in full (block capitals) First Middle Last b) Gender M ☐ F ☐ c) Marital Status , A P R I L 2 0 1 7 , 1 2 : 0 0 N O O N 1 27 T H Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 2. b) Passport No.

2. a) Nationality 3. a) Date of Birth DD/MM/YYYY b) Age (at last Birthday) c) Country of Birth 4.
Mailing Address Physical Address 5.

Telephone number(s) Home Mobile 6.

Email Address 7.

Occupation of Applicant 8.

Name, Address and telephone number of Applicant’s Employer 9.

Work Phone Fax 10.

Name of Parent/Guardian 11.

Occupation of Parent/Guardian 12.


Name, Address and telephone number of Parent/Guardian’ , A p r i l 2 0 1 7 , 1 2 : 0 0 N O O N 2 27 T H Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 B. APPLICANT’S QUALIFICATIONS: 13.

Enter Information Below Secondary/High School Educational Institution Exam Board Subject Grade Year 14.
Higher Educational Institution Certificate Diploma Degree Year 15.

Other C. COURSE INFORMATION: 16.

Name and address of University/College/Institution you will attend Tel: 17.

For what Degree or similar qualification do you intend to study?

(Cert., Dipl., Assoc., B.A., B.Sc., M.B.A., M.Sc., Ph.D.) 18.
Subject or Field of Study Major Minor , A p r i l 2 0 1 7 , 1 2 : 0 0 N O O N 3 27 T H Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 19.

Please Select Appropriate Mode of Study: ☐Overseas- On Campus ☐Distance Learning/Online Programme ☐Part-time: Local Institution DD/MM/YYYY DD/MM/YYYY 20.

Duration of Course (in years) 21.


Date of Commencement of Course 22.

Expected Date of Completion of Course 23.

Estimated Annual Cost of Course (EC$) 24.

Intended Career D. LOAN DETAILS (in EC Dollars) 25.

Loan Amount Requested (max.

$50,000.00) 26.

Number of Years to Repay Loan (max.

10 yrs.)

27.

Repayment option - Please select one of the following: ☐ Interest and Principal Payments will commence immediately.
Please indicate in the space below the name and number of the person who will make payments on your behalf: Cell: Home: Work: ☐Interest Payments will be made immediately Please indicate in the space below the name and number of the person who will make payments on your behalf: Cell: Home: Work , A p r i l 2 0 1 7 , 1 2 : 0 0 N O O N 4 27 T H Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 28.
Surety No.

1 Name Date of Birth Nationality Full Address Telephone numbers Email Address Occupation Name of Employer Address of Employer Employer Telephone Assets held by Surety Liabilities of Surety Surety No.

2 Name Date of Birth Nationality Full Address Telephone numbers Email Address Occupation Name of Employer Address of Employer Employer Telephone Assets held by Surety Liabilities of Surety E. OTHER FUNDING: (in EC dollars) 29.

Parental Contribution 30.

Own Contribution 31.


Other Sources of Funding: a) Funding Source (s) b) Amount 32.

Have you received a Grant from Board of Education?

☐Yes ☐No If Yes, please indicate year Grant was received DD/MM/YYYY , A P R I L 2 0 1 7 , 1 2 : 0 0 N O O N 27 T H 5 Government of Antigua and Barbuda FINANCE ADMINISTRATION ACT: National Student Loan Fund Regulations-2008 33.
Have you applied for/received any other Scholarship/Financial Aid?

☐ Yes ☐ No ☐ Pending If Yes, please indicate amount EC$ and year received Funding Source 34.
STUDENT BUDGET FORM: RELATED TO COURSE ONLY Year 1 EC$ Year 2 EC$ Year 3 EC$ Year 4 EC$ Income (Allocated to Studies) Self Parents Other Financial Aid Loans (Excluding NSLF) TOTAL INCOME Expenses (Relating to Studies) Rent Utilities - Water - Cable - Internet - Phone Food Transportation - Car Insurance - Gas - Public Transit Tuition Books Childcare Entertainment Other Total Expenses Excess/(Shortfall) [Income - Expenses] TOTAL SHORTFALL TOTAL AMOUNT REQUESTED FROM NSLF (Maximum of $50,000.00 , A P R I L 2 0 1 7 , 1 2 : 0 0 N O O N 27 T H 6 F. HOUSEHOLD INFORMATION 35.
Please provide the names, age, gender, occupation, telephone number and relation of all persons living in your household.

NAME AGE GENDER (M/F) RELATIONSHIP TO YOU OCCUPATION TELEPHONE 36.

Does anyone living in your household have a disability?

Yes ☐ No ☐ 37.

If Yes, please state the nature of the disability DECLARATION BY APPLICANT I declare that the statements contained in this application are, to the best of my knowledge, true and accurate.
I authorize the administrators of the National Student Loan Fund to seek verification of the information provided for the purposes of determining whether to approve this application.

If awarded a loan, I am willing to sign a student loan agreement and a bond.

I understand that if I fail to pay or honor the conditions of loan and bond agreement that the committee may take legal action to recover all outstanding amounts.
Signature of Applicant: Date: DD/MM/YYYY Please deliver one (1) copy of this form with supporting documents to: National Student Loan Fund Secretariat Ministry of Finance and Corporate Governance Parliament Drive St. John’s Antigua W.I.
, A p r i l 2 0 1 7 , 1 2 : 0 0 N O O N 27 ☐ Approved ☐ Not Approved AUTHORIZED SIGNATURES: Chairperson: Secretary: Date: Date: DD/MM/YYYY DD/MM/YYYY , A p r i l 2 0 1 7 , 1 2 : 0 0 N O O N 27 T H 8