SCHEDULE I – APPLICATION AND AGREEMENT FOR GRANTS.
HIGHER EDUCATION STUDENTS’ LOANS BOARD
No. 8, Block No. 46, Sam Nujoma Road, Mwenge; P.O.Box 76068, Dar es Salaam, Tanzania
Tel: (General) +255 22 2772432/2772433; Fax: +255 22 2700286; E-mail:
info@heslb.go.tz;
Website:
www.heslb.go.tz
APPLICATION AND AGREEMENT FOR GRANTS
Part I APPLICANT’S PARTICULARS
Full Name: _______________________________________ Sex:______
Date of Birth:________________________
District:___________________
Region:_____________________________
:________________________
Mobile Phone:_______________________
E-mail
2: EDUCATIONAL BACKGROUND
Name of O-level Secondary School:________________________________
Affix applicants photo
(passport size)
1: APPLICANT’S PERSONAL DETAILS
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Form Four Index :_________________
Name of A-level Secondary School :___________________________
Form Six Index :_________________
Grade Attained : (eg. Div I,II etc)________________________________
College Name:__________________________ Course____________________
Class attained: (first, second, etc):_________________________________
3: CURRENT COLLEGE DETAILS
Name of University/ College:________________________________ Reg. No: _____________
Course Registered:__________________________ Course duration:________________________
Expected year of graduation ________________
4: APPLICANT’S DECLARATION
I __________________________ hereby declare that all the information I provide in this application form, part of which is contained herein, is true to the best of my knowledge and that, I am fully aware that legal action can be taken against me in the event that the information given by me is found to be FALSE or misleading.
Applicant’s Full Name: ________________________________Date:
__________Signature___________
5: THIS PART MUST BE FILLED BY THE DEAN OF STUDENT OF STUDENTS/DIRECTOR OF STUDIES
I certify that the information given above is correct and that the applicant is a bonafide student of this Institution.
Full name of Dean /Director of studies ___________________________________
Date: ___________ Put Official Stamp here
Signature: _________________________
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