DETAILS OF STUDENT APPLICANT
Full Name of Student:
Date of Birth:
Place of Birth:
Nationality:
Gender: MaleFemale
Name of last school attended:
Name of high school to be attended:
DETAILS OF PARENT/GUARDIAN
Name of Parent/Guardian:
Relationship to Applicant: MotherFatherLegal Guardian
JTA Credit Union Membership Number:
Email Address:
Cell Phone:
Home Phone:
Home Address:
Work Address (Name of school & telephone #):
Nature of Employment: PermanentTemporary
Monthly Net Income: $10,000-$25,000$26,000-$40,000OVER $40,000
Other Dependents (excluding parents and spouses)
Name Relationship Age of Dependent
DECLARATION OF PARENT/GUARDIAN
I hereby declare that the statements made by me in answer to the foregoing questions are true and complete. I understand that willful misrepresentation renders the application ineligible for consideration and could be withdrawn.
Signature of Parent/Guardian
Date
I am involved in the following Co-curricular Activities:
This bursary is important to me because (This section is to be completed by the student)
School Assessment - Grade Teacher's Assessment of student
Name of Grade teacher:
Signature of Grade teacher:
Date:
CONDITIONS: 1. The applicant must have taken the PEP examination in the year of application 2. The parent or legal guardian of the applicant must be in good financial standing with the JTA Co-op Credit Union Ltd. for a minimum of one (1) year. 3. The applicant must not have already received a bursary or scholarship from another institution in relation to their PEP results 4. All applications must be accompanied by a copy of the applicant’s PEP result and Birth Certificate. Kindly email these additional documents to info@jtacreditunion.com with the child’s name as subject 5. All sections must be completed and all the required signatures affixed
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