Daffodil International University

Application for Financial Aid Fee: Taka 50 (fifty) only Application Form No:
Warning! Applicant must appear before the Viva-Board. Incomplete applications will not be processed. No application will be received after dead line. All information provided in this application is subject to scrutiny and verification. If any information is found to be untrue, the award will be cancelled and be referred to the Disciplinary Committee for action.

Instructions: Please write in block letters. Use permanent ink or a ball-point pen to fill this form. Do not leave any blank space write NA for items that do not apply to you. Please attach copies of all documents requested. 1. Application information. Students Name: ---------------------------------------------------------------------------------------Students ID # ------------------------------------------------------------------------------------------Program:-------------------------------------------------------------------------------------------------Fathers / Husbands Name: -------------------------------------------------------------------------Mothers Name:-----------------------------------------------------------------------------------------Date of Birth: -------------------------------------------- Nationality: --------------------------------Permanent address: Present family address: Dhaka residence, if you are not residing with your family

2. Category of Financial Aid applying for: (a) Result in H.S.C (b) Result in last Semester (c) Need based (d) Brothers/Sisters/Husband-Wife (e) Special Quota (f) Others

Application for Financial Aid 3. Academic information. Board Exams Year Division % Marks/ GPA

S.S.C H.S.C Bachelors Masters Other

GCE or others Subjects with Grades GPA

Performance at DIU Semesters Attended -----------------Credits Passed --------------------Semester GPA ---------------------CGPA -------------------Credits -------------------

O-level

A-level

i) ii) iii) iv) v) vi) i) ii) iii) iv)

vii) viii) ix) x)

4. Did you apply to DIU for financial aid ever before. Yes No From (term and year) If yes, please provide details: To (term and year) % waiver

i) ii) iii) iv) v) vi) vii) viii)

5. List all academic awards and scholarships received. Name of award / Scholarship From To Amount Remarks

i) ii) iii) iv)

6. List your family members including yourself. Name i) ii) iii) iv) v) vi) 7. List all members of your family employed in government, semi-government, NGO or private organization. Name Relationship Designation Employers name & In come per address year (Tk.) Relationship Age in year Occupation

i) ii) iii) iv)

8. List all members of your family in business. Name Relationship Name and type of business Address Annual income (Tk.)

i) ii) iii) iv)

9. Family housing information. Parent/ Guardians house Rented house 1.Owners Name. 1. Lessees Name. 2. Relationship. 3. House address. 2. Relationship. 3. House address. Employers quarter 1. Owners Name. 2. Relationship. 3. House address.

10. List of houses owned by your family members. (A). Owners Name: House address: Floor area: Present value: Relationship: Annual rent: Year of completion :

(B).Owners Name:

House address:

Floor area: Present value: Annual rent:

Relationship: Year of completion

11. Automobiles used by your family. Model (new/used/reconditioned) i) ii) Owned by Self/ Employer Self/Employer Year of purchase (if owned)

12. Financial Liabilities of the family (Bank loan, House Building loan, Personal loan etc.) if any, with details. (a) Name of Bank/ Institutions (b) Amount of loan taken: Tk. (c) Amount of outstanding Balance: Tk.

13. Total annual income of the family (parents/guardians). Particulars i) Salary Income ii) Business Income iii) Rental Income iv) Income on Investment v) Agricultural Income vi) Other source of Income Total 14. Annual family Expenditure. Particulars i) Your education expense at DIU ii) Education expenses for other family members. iii) House rent. iv) Foreign travels (other than business) v) Medical emergencies vi) Income tax vii) Other taxes viii) Other expenses (living exp. Social obligation, electricity /gas/wasa/ phone bill, conveyance etc). ix) Vehicle maintenance with fuel & Drivers expenses in any Total: 15. List sources or persons who are currently paying for your education.
Name i) ii) iii) Relationship Address Occupation Annual income

Amount (In Tk.)

Amount (In Tk.)

16. Declaration by applicant: I declare that the information provided above are, to the best of my knowledge, true and correct. I do also declare that if financial aid is granted to me I will be bound by the rules and regulations of the university and the DIU code of conduct.

17. Please mention two references: (A) Name------------------------------------------- (B) Name----------------------------------------------Occupation:---------------------------------------Occupation:---------------------------------------Address:---------------------------------------------- Address:---------------------------------------------Telephone No:------------------------------------Telephone No:------------------------------------E-Mail No :----------------------------------------E-Mail No :---------------------------------------Signature: Signature: ---------------------------------------------Signature of applicant Date:---------------------------------------------------------------------------------Signature of parent /guardian Date: -------------------------------------------

Money Receipt No.

Acknowledgement of Accounts

Appeared for interview Observation. If any:

Yes

No

Remarks, If any:

No Financial Aid Granted

Percentage -------------------/ Amount of Financial Aid Granted.

----------------------------------------Financial Aid Officer

102,Sukrabad, Mirpur Road, Dhanmondi, Dhaka-1207.Phone: 9138234,9138235,9116774,Fax: 880-2-8117282 E-mail: info_diu@daffodilnet.com, ragistrar_diu@daffodilnet.com Web: www.Daffodilvarsity.edu.bd

Financial Aid Application Form

DAFFODIL INTERNATIONAL UNIVERSITY

102, Sukrabad, Mirpur Road, Dhanmondi, Dhaka-1207.Phone: 9138234,9138235,9116774, Fax: 880-2-8117282 E-mail: info_diu@daffodilnet.com, Web: www.daffodilvarsity.edu.bd