USI #
Student Application Form
Academic Year 2024/2025
Form to be filled in BLOCK letters. NO gel ink pens, white out, scratches or trace over.
For students under 18 years, parent or guardian is required to sign and submit a copy of ID card.
• Due Date for Submission of Loan Applications forms for AY 2024/2025 May 16, 2025. *Subject to Change
SECTION A: PERSONAL PARTICULARS OF APPLICANT
Last Name First Name Other Name Maiden Name Campus
Turkeyen
Date of Birth Gender Marital Status Nationality Tain
NIS # NID # Passport # TIN #
Last School/Institute Attended Highest Academic Achievement
CSEC /CXC CAPE GCE O/A LEVELS
DIPLOMA DEGREE CERTIFICATE
SECTION B: APPLICANT CONTACT INFORMATION
Mailing Address Telephone (#) E-mail Address
Permanent Address
SECTION C: PARTICULARS OF APPLICATION
Academic Year Loan Type Time Basis Amount Requested
2024-2025 Entire Year Full Time
Semester 1 Part Time
Semester 2/3
Faculty Program Previous Loan?
Yes No
Employed? Place of Employment Occupation Gross Income ($)
Yes No
SECTION D: DECLARATION
By signing below, the student affirms that the information provided on this application form is true and complete
and that no required information is withheld. The student also agrees that the Student Loan Agency, Ministry of
Finance may cancel any or all loan(s) and request immediate repayment of all monies owed if false information
is detected. The student also authorizes the sharing of any or all current and historic personal and/or loan
information provided or concluded for the purpose of credit reporting as required by the Government of the
Cooperative Republic of Guyana. Where permitted, the student agrees to extend any limitation period
applicable to the loans for six (6) years or any longer period permitted by the applicable law.
Date Student’s Signature Witness
Guarantor’s Signature Signature of Parent/ Guardian & Copy Parent’s ID (if
Applicant is under 18 years old)
USI #
Student Application Form
Academic Year 2024/2025
Form to be filled in BLOCK letters. NO gel ink pens, white out, scratches or trace over.
For students under 18 years, parent or guardian is required to sign and submit a copy of ID card.
