INDEPENDENT DEVELOPMENT TRUST BURSARYAPPLICATION FORM

Transcription

1 INDEPENDENT DEVELOPMENT TRUST BURSARYAPPLICATION FORM Important to note: Please complete this form thoroughly and accurately to assist the IDT to select and award bursaries to the most suitable candidates Please mark with an X in the applicable response where required This document is not in any way an agreement or commitment The selection of learners is totally dependent on excellent results obtained and the outcome of the selection process Closing Date: 30 October - late applications will be accepted Additional information required Cover letter stating why you should be considered for a bursary Certified copy of ID Certified copies of full official academic transcripts Proof of provisional acceptance at institution (where applicable) Proof of parent s income statement/ salary advice Affidavit if parents are unemployed PART A: ACADEMIC INFORMATION *STUDY DISCIPLINE Building Science Architect Civil Engineering Quantity Survey Occupational health and safety MARK WITH X PART B: PERSONAL INFORMATION Surname: First names Id Number Date Of Birth Gender Male Female Race African White Coloured Asian Do you have a disability? Are you a South African Citizen? If, what is your nationality? Have you ever been convicted of a criminal offence or been dismissed from employment? Page 1 of 6

2 PART C: CONTACT DETAILS Contact Numbers Cell: Alternative: Permanent postal address Permanent residential address Postal Code: Address Postal Code: PART D: EDUCATIONAL PARTICULARS (PLEASE COMPLETE IN FULL) Current studies (e.g grade 12 or 1 st year student): Secondary Education (Please provide copy of certified matric results) Name of Institution Highest qualification obtained Subject Symbol Tertiary Education Name of Institution Degree/Diploma Major Subjects Year Obtained Page 2 of 6

3 If you are not currently enrolled at the University/Institution and have completed matric, please indicate your current activities PART E: PARTICULARS OF THE DEGREE FOR WHICH YOU WISH TO RECEIVE A BURSARY Please state the qualification you will be pursuing (name of diploma or degree) Qualification level Undergraduate Honours Masters Doctorate At which University/Institution do you wish to study? Level of study if you are already at tertiary level Year 1 Year 2 Year 3 Year 4 Have you been provisionally accepted at the University? (Please provide proof) Do you intend staying at eh University residence? What is the estimated cost of your studies per annum? R What is the estimated cost for the residence per annum? R Page 3 of 6

4 PART F: FINANCIAL INFORMATION Do you currently have a bursary/ study loan If you have a bursary, who is your sponsor? If you have a study loan what is the current value of the Study loan? R Please describe any obligations/contracts you may have with your sponsor Father s Occupation Mother s Occupation Guardian s Occupation t applicable t applicable t applicable Mark your father s monthly income before any deductions (attach proof) >R R R R R R R R R Mark your Mother s monthly income (attach proof) >R R R R R R R R R Mark your Guardian s monthly income (attach proof) >R R R R R R R R R Page 4 of 6

5 How many dependents are still at home? How many dependents are still at tertiary institutions? How many dependents are still at school? PART F: RELATIVES EMPLOYED BY THE IDT Do you have relatives who work for the IDT? If yes what is the relationship between you and the IDT employee What position does your relative hold in the IDT? Page 5 of 6

6 PART G: DECLARATION I understand that all the information provided in my application may be followed up and I authorise the IDT to contact any relevant person or institution for relevant references 1. I declare that the above information to my knowledge, is true and correct and accept that if it were to be found that I withheld any information, my application will be cancelled immediately 2. I authorise any school/ University/ Employer to provide the IDT with relevant information that may be useful in making a decision Signature of Applicant Date: Signature of Parents/Guardian, if still a minor Date: 0FFICE USE ONLY Captured Date: Comments: Interview Regret Other Signature Page 6 of 6