KUATI BURSARY APPLICATION FORM

Transcription

1 KUATI BURSARY APPLICATION FORM 2017/2018 SPESNETKUATI PTY LTD Crossway Office Park, Building B240 Lenchen Ave, Centurion

2 Instructions: 1. Read carefully before completing, signing or submitting this form. 2. Ensure that this form is completed in full. 3. Complete in BLOCK LETTERS. 4. te that this bursary cannot be used to pay for existing loans or debts. 5. Bursaries will be allocated for the year following the one in which the application was received. Criteria: 1. Ensure that this form is duly signed. 2. Application forms with incomplete information will be disqualified. 3. Application forms with incorrect information will lead to your application being disqualified. 4. Availability for a panel interview 5. Terms and Conditions will apply Attach all of the following required documents: Certified copy of a valid Senior Certificate (if you have completed Grade 12). If applicable, a certified copy of your latest academic transcript or examination results with an official letterhead from your school. Certified copy of a valid South African identity document/passport. Do not send original documents. Attach required certified copies to the back of the application form. Original Application Forms must be submitted. A passport size photograph of the applicant must be attached to the application form in the allocated space. Submit completed forms by one of the following: execuboard@kuati.co.za OR Fax: OR Post: KUATI PO Box 8630 Centurion 0046 For attention: Wendy Pringle-Bekker 1 P a g e

3 1. Surname 2. First Names 3. Date of Birth 4. Place of Birth Identity / 5. Passport. PASSPORT PHOTO 6. SA Citizenship 7. Gender Male Female 8. Race African Indian Coloure White 9. Disabilities If YES, describe the nature of the disability: 10. Residential Address with postal code 11. Postal address with postal code Contact 12. telephone numbers incl dialling codes Home Parent/ Cellular Other Guardian Contacts 13. address Person we can 14. contact if we need to contact you urgently Have you ever 15. been found guilty of a criminal offence? Highest 16. Qualification obtained Are you 17. currently Employed? State the career you wish to follow Have you applied for a bursary with KUATI before? Name: Tel no: Relationship: If yes, please specify the nature and date of offence: Institute: Specify: Year: Year: Have you applied to other company/ies for a bursary? How did you hear about this course? State which company/ies: Word of Advertisement Workshop Other mouth 2 P a g e

4 23. Do you have: A Computer Internet access Transport to Y N Y N Y N Centurion What were your favourite subjects at school? What Sport or Cultural activities did you participate in? What level did you achieve? Have you achieved any accomplishments that you believe are noteworthy? That is in the academic, sport, cultural or social fields. Describe this accomplishment. In no more than 200 words, briefly describe why you are interested in a career in healthcare? 3 P a g e

5 In no more than 500 words, elaborate why you believe you deserve the grant to complete this certification programme. I declare that the information stated on this application form is true and that any missing information will result in immediate termination of application and/or programme attendance under the scholarship programme 4 P a g e

6 Terms and Conditions: 1. Students bear the responsibility to be diligent in learning and carrying out research with a view to exiting with the required qualifications within reasonable timelines. 2. correspondence sent to KUATI shall be deemed to have been received until KUATI has responded thereto in writing. 3. The bursary holder will notify KUATI immediately of any change in the circumstances under which the bursary was awarded that might affect the award of the bursary. Should the bursary holder fail to do this, the bursary maybe cancelled by KUATI with immediate effect. 4. The KUATI bursary could cover tuition fees and course material. 5. KUATI may cancel the bursary if it is not taken up by the dated indicated on the letter of award. 6. Should the student be unsuccessful in his/her first attempt at the registered module examination, a supplementary examination may be written. Should the student be unsuccessful in both the examination and the supplementary, he/she will no longer receive the KUATHI bursary and be un-enrolled from the programme. 7. A student who repeats a module will do so at his/her own expense. If he/she passes, he/she may re-apply for a bursary for the following module. Assistance will not be automatically granted. 8. The continuation of KUATI bursaries for subsequent years of study will be subject to the student progress and the availability of funds. 9. Bursaries are not transferable. Declaration: I declare that I have read and understood the contents of this bursary application form, and information supplied by me is true and correct. I also understand that should any of the information/documents herein be proved to be incorrect or falsified, disciplinary action will be taken against me. I hereby acknowledge that I have read, understand and agree to the terms and conditions on this registration form. Signature of Applicate:.. Place: Date:. 5 P a g e

7 OFFICE USE ONLY: RECEIVED: TICK SIGNATURE Application Form Senior Certificate Other Examination results SA Identity document Passport photo DATE RECEIVED: APPROVED: Letter of award / Letter of denial sent to applicate DATE ENROLMENT DATE /SEMESTER JUNE / JANUARY NOT APPROVED: REASON(S) SIGNATURE 6 P a g e