Robert Gibson Bursary Application Form

NOTE TO APPLICANTS - The more information you can supply the better.

Full name of applicant

First

Middle

Last

Gender

Male

Female

Postal address

Address

Address 2

City/Town

Region

Postcode

Email address

Bank Account

Number for Payment of Bursary

Date of Birth

Phone Number

No. of dependents on parents/guardians

Fathers/Guardians details

First

Middle

Last

Address

Address 2

City/Town

Region

Postcode

Mothers/Guardians details

First

Middle

Last

Address

Address 2

City/Town

Region

Postcode

Parents/Guardians occupations (NB: if you are an orphan, this should be stated)

Fathers Occupation

Mothers Occupation

Are you married?

Yes

What religion/denomination are you?

Education institution to be attended

Course of study to be pursued

Have you had previous assistance from the Trust?

Yes

Details of previous assistance

Years

Amount $

Previous academic qualifications and details of schools attended. Include reports.

Are you entitled to apply for any other bursary?

Yes

If yes give brief details

Did you receive any other bursaries last year other than Robert Gibson?

Yes

If yes, how much did you receive? $

What is the current taxable income of

	Gross (Per Annum)	Net (Per Annum)
Main income earning parent or guardian	Main income earning parent or guardian (Gross) $	Main income earning parent or guardian (Net) $
Second income earning parent or guardian	Second income earning parent or guardian (Gross) $	Second income earning parent or guardian (Net) $
Yourself	Your income (Gross) $	Your income (Net) $

Do you have access to funds from an estate or trust?

Yes

If yes, how much do you expect this year? $

Anticipated details of how your course is to be financed for the year?

Receipts	Per Annum	Payments	Per Annum
Bursaries and Grants	Bursaries and Grants $	University or College fees	University or College fees $
Student/Independent allowance	Student/Independent allowance $	Accommodation	Accommodation $
Anticipated earnings	Anticipated earnings $	Books	Books $
Any other income	Other income $	Travelling	Travelling $
		Other expenditure	Other expenditure $
Sub Total	Receipt Sub Total $		Payment Sub Total $
Estimated deficiency (difference between Payments and Receipts)	Estimated deficency $

Assets (what you own)		Liabilities (what you owe)
Cash or Bank account	Cash or Bank account $	Student Loan	Student Loan $
Vehicle	Vehicle $	Other	Other Liabilities $
Other	Other Assets $
Sub Total	Assets Sub Total $		Liabilities Sub Total $

Supporting Documents

Choose files

Please attach any support documents in PDF format to be submitted with your application. Without these, your application can not proceed.

Maximum 5 files.
16 MB limit.
Allowed types: pdf.

I confirm the information supplied is correct