Apply for Funding

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SECTION A: APPLICANT CATEGORY

Please tick one *

Widow
Needy Child (to be completed by parent/guardian)
Student
General Applicant

SECTION B: APPLICANT PERSONAL INFORMATION

Full Name *

First

Middle

Last

Sex *

Male
Female

Date of Birth

Age

Nationality

Ghana Card Number (if available)

Marital Status

Single
Married
Widowed
Divorced
Other

Residential Address

Landmark/Location (give brief description)

Region

Digital Address

Phone Number(s)

Email Address (if any)

of any Card

SECTION C: HOUSEHOLD & DEPENDANTS INFORMATION

Number of Children

Are any of the children currently in school?

Do you have any dependents other than your children?

If yes, please specify

SECTION D: ECONOMIC & LIVING CONDITIONS

Do you have any source of income?

If yes, specify

Are you receiving any other support?

If yes, from where?

Average Monthly Income (if any)

Type of Housing

Own House
Rented
Family House
Temporary / No Fixed Residence

SECTION E: GRANT REQUEST

What type of support are you requesting? (tick all that apply)

Financial Grant
Small Business Support
Educational Support
Health Care
Housing
Food / Basic Needs
Other (please specify)

Briefly explain why you need this support

Amount Requested (if applicable)

SECTION F: CATEGORY-SPECIFIC INFORMATION

FOR WIDOW APPLICANTS ONLY

Name of Late Spouse

Date of Death

Do you have a Death Certificate?

(If yes, attach a copy)

(If no, applicant must provide at least one official or legal verified documents as proof of widowhood. Please tick document submitted.

Burial Permit
Probate or Letters of Administration
Sworn Affidavit
Funeral Poster or Obituary
Other (specify)

Single Line Text

Upload File

Drag & Drop Files, Choose Files to Upload

FOR NEEDY CHILD APPLICANTS (Parent/Guardian to complete)

Child’s Full Name

Date of Birth

Child's Age

Parent/Guardian Name

Applicant’s Relationship to Child

Mother
Father
Legal Guardian

Parent/Guardian Phone Number

Do you have child’s Birth Certificate?

(If yes, attach a copy)

(If no, applicant must provide at least one official or legal verified documents as proof. Please tick document submitted.

Sworn Affidavit confirming maternity/paternity
Child Health Record/Weighing Card
Hospital Birth Record
Baptismal / Naming Certificate
Other (specify)

Single Line Text

Upload File

Drag & Drop Files, Choose Files to Upload

School’s Contact

School's Name

Class/Form

Reason child needs support (education, health, feeding, etc.)

STUDENT APPLICANTS

Telephone Number *

Email *

Current School/Institution

School’s Contact number

Form/Level

Course of Study

Parent/Guardian Name

Contact Number

Type of Support Requested (tick all that apply

Tuition
Books & Study Materials
Accommodation
Feeding / Upkeep
☐ Other (specify)

Single Line Text

GENERAL APPLICANTS

Current Occupation/Status

Monthly Income (if any)

Main Challenges You Are Facing (tick all that apply)

Food
Children’s Education
Health Care
Housing
Employment / Business Capital
Other (specify)

Single Line Text

SECTION G: SUPPORTING DOCUMENTS – tick where applicable (Attach Copies)

Checkboxes

Ghana Card
Birth Certificate(s) of biological children
One Passport Picture
Death Certificate (Widows only)
Academic School Report (Student/Child only)
Admission Letter (Student/Child only)
Medical Report (Medical Requests)
Recommendation Letter
Any Other Supporting Document as applicable

SECTION H: DECLARATION & CONSENT

declare that the information and documents provided in this application are true and correct to the best of my knowledge. I understand that providing false information may result in disqualification.

Applicant/Guardian Signature

Date

SECTION I: REFEREE/GUARANTOR

Name

Position

Phone Number

Signature

Date

INSTRUCTIONS FOR COMPLETING THE FUNDING APPLICATION FORM

SECTION A: APPLICANT CATEGORY

SECTION B: APPLICANT PERSONAL INFORMATION

SECTION C: HOUSEHOLD & DEPENDANTS INFORMATION

SECTION D: ECONOMIC & LIVING CONDITIONS

SECTION E: GRANT REQUEST

SECTION F: CATEGORY-SPECIFIC INFORMATION

SECTION G: SUPPORTING DOCUMENTS – tick where applicable (Attach Copies)

SECTION H: DECLARATION & CONSENT

SECTION I: REFEREE/GUARANTOR

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