DATAS Bursary Application Form

Application for Financial Assistance

Bursary

- Please enter N/A for all areas that may not apply.
- Approval Status
- Upload your Passport Sized Photo for your application. Photos must be 2″x2″ in size with a background that is uniform, plain and white, and free of shadows
- Applicant Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit year
- National Identification Number
- Gender
- Marital Status
- Country of Birth
- Nationality
- Occupation
- Email Address
  example@example.com
- Length of Residence in Tobago
- Village of Residence
- Local Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Mailing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Present Foreign Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Mobile Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Home Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Work Number
  Please enter a valid phone number.Format: (000) 000-0000.

Please enter N/A for all areas that may not apply.

State the last institution attended first.

Rows	Institutions	Entry	Leaving	Certificate/Diplomas/Professional Qualifications Obtained
1.
2.
3.
4.
5.
6.
7.
8.

Professional Qualifications, Membership of Professional Societies and Military Service (Dates and Rank Applicable):
Community Involvement:
Hobbies and Interests:

Employment Record. Most recent job first.

Rows	Employer's Name	Position Held	Monthly Gross Salary $	From MM-YYYY	To MM-YYYY
1.
2.
3.
4.
5

SECTION C - Family Information
Please enter N/A for all areas that may not apply.

Rows	Names of Other Persons in Household	Date of Birth (DD- MM- YYYY)	Relationship	Occupation/School	Monthly Salary (If Any) $	STD/FORM/YEAR
1.
2.
3.
4.
5

Father's Name (Even if deceased):

First NameLast Name
Father's Occupation:
Annual Income:
Village of Origin

Children of Father:

Rows	Name	Age	Occupation/Institution
1
2
3
4
5
6
7
8
9
10

Mother's Name (Even if deceased):

First NameMaiden NameLast Name
Mother's Occupation:
Annual Income
Village of Origin

Children of Mother:

Rows	Name	Age	Occupation/Institution
1
2
3
4
5
6
7
8
9
10

SECTION D - Programme Details
Please enter N/A for all areas that may not apply.
Level of Programme:
Name of Programme:
Name of Institution
Campus:
Address of Institution

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mode of Study
Disability (If any, please state)
School Started
If yes, state academic year started
e.g. 2021/2022
Please name all uploads appropriately.
File Upload - National Identification (front and back)

Cancelof
File Upload - Passport (Biodata page 2)

Cancelof
File Upload - Electronic Birth Certificate

Cancelof
File Upload - Certificates, Degrees or Diplomas

Cancelof
File Upload - Acceptance Letter

Cancelof
File Upload - Course Outline

Cancelof
File Upload - Statement of Benefit to Tobago

Cancelof
File Upload - Official Transcript

Cancelof
File Upload - Accreditation Letter except UTT, UWI & COSTATT

Cancelof
File Upload - Medical Certificate

Cancelof
File Upload - Curriculum Vitae/ Resume

Cancelof
File Upload - Recommendation Letter 1

Cancelof
File Upload - Recommendation Letter 2

Cancelof
File Upload - Annual Cost Information

Cancelof
File Upload Status Letter - Already started the programme?

Cancelof
File Upload - Proof of income (Payslip /job letter if employed) or (Income expenditure statement) or additional documents.

Cancelof

SECTION E - Financial Assistance Required
Please enter N/A for all areas that may not apply.

Purpose and amount of financial assistance required for the ENTIRE DURATION of the course of study. All currency values should be expressed in Trinidad and Tobago (TTD). Enter all cash values using the format e.g. 1,000.00

Rows	$	$	$	$	$	Totals
Academic Year(s)
1. Tuition
2. Books
3. Supplies
4. Accommodation
5. Meals
6. Transportation
7. Miscellaneous
GRAND TOTAL

Personal contribution to course of study
Contribution to course of study by parent, guardian or spouse
A Total Cost Required
B Total Contribution
Amount Required (A-B)
Exchange Rate
Currency
Is the programme GATE funded?
Have you applied for GATE?
If you did not apply or not eligible for GATE, please state reason.

GATE Clearance Information.

Rows	Year	Means Rate %	Amount
1

Other sources of Scholarships (from present University/College or any other institution).

Rows	Year	Amount	Institution	Name of Scholarship/Fund
1
2
3
4

Upload supporting documents for other Sources of Scholarships or GATE

Cancelof

SECTION F - Previous Financial Assistance
Please enter N/A for all areas that may not apply.

Previous financial assistance from the Tobago House of Assembly. Enter all cash values using the format e.g. 1,000.00

Rows	Year	Amount $	Divison/Department	Institution Attended	Programme
1
2
3
4
5

Relatives who received financial assistance from the Tobago House of Assembly e.g. (mother, father, sister, brother, uncle, aunt etc.) Enter all cash values using the format e.g. 1,000.00

Rows	Name	Relationship	Year	Amount $	Institution	Programme
1
2
3
4
5

SECTION G - Statement of Monthly Expenditure
Please enter N/A for all areas that may not apply.

Expenditure - Enter all cash values using the format e.g. 1,000.00

Rows	INDIVIDUAL $	HOUSEHOLD $
(i) Bank
(ii) Credit Union
(iii) Government
(iv) Insurance
(v) Other
Mortgage
Rent
Food
Transport
Utilities
(i) Telephone
(ii) Electricity
(iii) Water
House Taxes
Miscellaneous
TOTAL EXPENDITURE

Assets - Enter all cash values using the format e.g. 1,000.00

Rows	INDIVIDUAL VALUE $	HOUSEHOLD VALUE $
Bank Accounts
Fixed Deposits
Other Shares/Units
Credit Union Shares
Life Insurance CSV
Real Estate
Vehicle
Furniture/Appliances
Other
TOTAL

Liabilities - Enter all cash values using the format e.g. 1,000.00

Rows	INDIVIDUAL OUSTANDING BALANCE $	INDIVIDUAL MONTHLY PAYMENTS $	HOUSEHOLD OUTSTANDING BALANCE $	HOUSEHOLD MONTHLY PAYMENTS $
Bank Overdrafts
Bank Loans
Credit Card(s)
Credit Union Loans
Monthly Rent/Mortgage
Hire Purchase
Other
TOTAL

SECTION H - Public Officers
Please enter N/A for all areas that may not apply.
FORM A
1. Applicants employed with the Government of Trinidad and Tobago or the Tobago House of Assembly must submit their application through their respective Ministries/Divisions for comments and the recommendation of the Permanent Secretary/Administrator and head of Divisions/Departments. FORM A MUST be uploaded with the application. Applications not following this directive will not be accepted without being reviewed.

Cancelof
If you are pursuing the programme on a part time basis during working hours, you must produce written evidence that you have been granted time off in the form of a letter from the Permanent Secretary, Administrator or head of Divisions/Departments.

Cancelof

SECTION I - Declaration by Applicant
I declare that I am a resident of Tobago and that all statements made in this application are to the best of my knowledge, TRUE, COMPLETE and ACCURATE. If awarded financial assistance, the THA reserves the right to publish the award. I undertake to report in writing to the THA at the end of the award period. I understand that if there is any false representation, this application will be rendered invalid.
DATAS OFFICER'S NOTES:

Rows	Check If Received	Remarks
1. Recent PASSPORT-SIZED Photo
2. National Identification Card (front and back)
3. Electronic Birth Certificate
4. Passport Bio-data page (page 2)
5. Statement of Benefit to Tobago
6. Certificates, Degrees or Diplomas
7. Acceptance Letter
8. Programme Description/Outline
9. Annual Cost Document
10. Statement of Recognition
11. Official Transcript
12. Recommendation x2
13. Medical Certificate
14. Curriculum Vitae/Resume
15. Form A (if applicable)
16. GATE documents (if applicable)
17. Scholarships (if applicable)
18. Proof of Income

Application for Financial Assistance

SECTION C - Family Information

SECTION D - Programme Details

SECTION E - Financial Assistance Required

SECTION F - Previous Financial Assistance

SECTION G - Statement of Monthly Expenditure

SECTION H - Public Officers

SECTION I - Declaration by Applicant

Section J - DATAS OFFICIAL USE ONLY

-FOR OFFICIAL USE ONLY-