6
RHODES STUDENT NUMBER
INITIALS SURNAME
APPLICATION FOR FINANCIAL ASSISTANCE FOR YEAR
NOTE:
. Please complete this form in all respects
. All relevant documents as requested in checklist are attached
. All family income must disclosed in full
Late applications will not be considered
SECTION 1 Details of Applicant
Surname
First Name
Identity number
Cell phone number
For which degree are you
registered?
Email address
Married Divorced Single Deceased Married But Living Apart
Have you had funding from NSFAS YES No
For how many years has NSFAS
Funded your studies
SECTION 2 Family Details
Father, Guardian
Father/ Guardian
Surname
First Name/s
Identity number
Relationship to student
Employer’s Name
Gross Earnings
Other Income
Email:
Cell
Employed Unemployed Pension Self Employed- Informal Sector
Mother, Guardian
Mother / Wife
Surname
First Name/s
Identity number
Relationship to student
Employer’s Name
Gross Earnings
Other Income
Email:
Cell
Employed Unemployed Pension Self Employed- Informal Sector
Husband, Wife
Husband/ Wife
Surname
First Name/s
Identity number
Relationship to student
Employer’s Name
Gross Earnings
Other Income
Email:
Cell
Employed Unemployed Pension Self Employed- Informal Sector
SECTION 3 List of All Family Members Dependent on Family Income and
Living in Your Home
Name Age Relationship If not Occupation Employed Position Income
direct Yes/No Held
family
E.g. Sipho 21 Brother Student Yes Waiter R300pm
Total number of people living in your home…………….
NB!! IF YOU HAVE A BROTHER OR SISTER WHO IS A STUDENT AT A REGISTERED
TERTIARY INSTITUTION, PLEASE SUPPLY PROOF OF REGISTRATION.
SECTION 4 Declaration by Applicant (Student)
I hereby confirm that……………………………………… (Student’s name) understand that financial aid is available to students
who are financially deserving and fully declared of all family income. I have read and attached documents as listed in the
checklist which accompanied the issue of this application form.
I understand that my application form will not be considered unless the form is fully completed and all requested documents are
attached.
I agree that Rhodes University Financial Aid Office may confirm the details I have provided.
I agree that my details may be submitted to sponsors in an attempt to obtain external funding (bursaries).
I declare that to the best of my knowledge full and detailed particulars regarding my family’s financial situation have been
provided. I understand that intentional submission of incorrect/incomplete details constitutes a disciplinary offence.
Signature of Applicant (Student)……………………………………………….Date…………………………………………….
Signature of Commissioner of Oaths……………………………………………………………………………………………...
Date ……………………………………..Official Stamp…………………………………………………………………………
SECTION 5 Declaration By Head of Household
(To be signed in the presence of a commissioner of oaths)
I, …………………………………………………………………………………………………………..( Name and Surname),
ID no……………………………………….have read and understood this Application for Financial Assistance. Where I have
not understood a question this has been explained to me. I have checked the information provided in this application form and
declare that to the best of my knowledge the details provided of the family’s ENTIRE financial situation are complete and
correct.
Signature of Head of Household……………………………………………….Date…………………………………………….
Signature of Commissioner of Oaths……………………………………………………………………………………………...
Date ……………………………………..Official Stamp…………………………………………………………………………
