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Lillah Bursary Application Form
Full Name of Applicant
Date of Birth
Identity Number
Current Grade / Year of Study
Institution Currently Attending
Applying for:
Secondary School
Tertiary Education
Field of Study (if tertiary)
Full Name of Parent/Guardian
Home Contact Number
Work Contact Number
Mobile Contact Number
Email Address
Residential Address
Employment Status
Employed
Unemployed
Self-employed
Employer Name
Institution you are applying to/enrolled at
Type of Institution: Semi-private (ex-Model C) / Government university
Semi-private
ex-Model C
Government university
Subjects chosen (for secondary learners)
Degree/Career choice (for tertiary learners)
Current Institution
Average Grade/Percentage
Financial Justification Please motivate why financial support is required. Include household income, dependents, and any special circumstances
Applied for NSFAS? (Yes/No)
Yes
No
Outcome of NSFAS application
Applied for institution’s bursary/scholarship? (Yes/No)
Yes
No
Outcome of institution application
Copy of applicant’s ID
Proof of latest academic results
Proof of enrolment/acceptance letter from institution
Proof of income of parent/guardian(s)
Letter of rejection from NSFAS
Letter of rejection from the institution’s own bursary/scholarship scheme
Section 7: Declaration
I, the undersigned, declare that the information provided is true and correct. I understand that:
• The bursary may be partial and not cover 100% of fees.
• Any misconduct or failing an academic year (without mitigating circumstances) may disqualify me from future funding.
• Awards are at the discretion of the Scheme Committee.
Applicant Name:
Date
Parent/Guardian Signature:
Date
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