BURSARY APPLICATION -2018

Transcription

1 Dear applicant Read the instructins carefully befre filling in the applicatin frm THE APPLICATION FORM MUST BE RETURNED TO SIOC COMMUNITY DEVELOPMENT TRUST (SIOC-cdt) BEFORE THE 1 ST DECEMBER 2017 APPLICATION TO REACH SIOC-CDT IN EITHER OF THE FOLLOWING METHODS: POST HAND DELIVERY MS KEITUMETSE TLHAOLE P.O. BOX KATHU 8446 keitumetse@sic-cdt.c.za SIOC-CDT OFFICE PARK CORNER HENDRICK VAN ECK AND IAN FLEMMING ROAD KATHU 8446 OR GODISANG THABAZIMBI COMMUNITY DEVELOPMENT TRUST 11 JOURDAN STREET THABAZIMBI INSTRUCTIONS FOR THE SUBMISSION OF APPLICATION FORMS SIOC-cdt will nly cnsider yur applicatin if yu have taken care t cmplete it legibly, in full ensuring that all required dcuments have been included. 2. CHECKLIST OF DOCUMENTS/ITEMS TO BE INCLUDED WITH YOUR APPLICATION FORM: A certified cpy f yur June (current year) matric/cllege/university results Prf f acceptance/registratin at a public and recgnised institutin f higher learning A ne-page cver letter t mtivate yur need fr financial assistance. A certified cpy f yur Suth African ID Prf f residence Prf f incme f parent(s) r guardian r affidavit certifying absence theref Medical nte f type f disability where applicable 3. SELECTION CRITERIA SA citizen r permanent resident frm Yunger than 30 years ld Average pass mark f 65% In financial need Living with a disability SIOC-cdt 2018 Bursary Applicatin Frm

2 4. QUALIFICATIONS APPLIED FOR MBChB Turism Law B.Ed varius specialisatins Agriculture varius specialisatins Engineering including cnstructin management, architecture, quantity surveying B.Cmm varius specialisatins A. STUDY DETAILS IF CURRENTLY AT UNIVERSITY / COLLEGE / UNIVERISTY OF TECHNOLOGY INSTITUTION CAMPUS STUDENT YEAR OF STUDY (E.g. 1 st, 2 nd, S1/S2) B. DEGREE DETAILS PROPOSED COURSE DEGREE (E.g. BSc, BCm, NDip, BTech) COURSE (E.g. Mining Engineering, Accuntancy) C. SCHOOL DETAILS CURRENT SCHOOL NAME SCHOOL ADDRESS SCHOOL TELEPHONE NO. PROPOSED UNIVERSITY / COLLEGE / UNIVERISTY OF TECHNOLOGY SIOC-cdt 2018 Bursary Applicatin Frm

3 5. PERSONAL DETAILS TITLE (MR, MRS, MS) INITIALS IDENTITY RACE MALE FEMALE SURNAME FIRST NAMES IN FULL DATE OF BIRTH (d:m:y) AGE AT DEC 17 POSTAL ADDRESS PHYSICAL ADDRESS POSTAL CODE PROVINCE HOME TELEPHONE APPLICANT CELL ADDRESS AREA CODE ALTERNATIVE CELL POSTAL CODE PROVINCE EMERGENCY CONTACT NAME PLACE OF BIRTH SA CITIZEN Yes OR Permanent Resident Yes MARITAL STATUS Single D yu have any disability? OR Married (Give details f any such disability and nature f assistance required as part) DO YOU SUFFER FROM ANY CHRONIC ILL NESS OR PHYSICAL HANDICAP? If yes, please give details HAVE YOU BEEN CONVICTED OF ANY CRIME? YES NO YES NO If yes, please give details SIOC-cdt 2018 Bursary Applicatin Frm

4 6. PARENT / GUARDIAN DETAILS TITLE (MR, MRS, MS, DR, etc.) INITIALS IDENTITY NATURE OF RELATIONSHIP SURNAME FIRST NAMES IN FULL OCCUPATION PLACE OF WORK HOME TELEPHONE WORK TELEPHONE AREA CODE AREA CODE FAX AREA CODE CELL ADDRESS 7. ACHIEVEMENTS Give details f all yur activities at schl r in the cmmunity, and yur rle in them: i.e. Leadership, sprt, cultural, etc. SCHOOL / COMMUNITY / ACADEMIC / SPORT / CULTURAL Give details f any activity (academic r therwise) in which yu have dne well at schl r fr which yu received awards: SIOC-cdt 2018 Bursary Applicatin Frm

5 8. WORK EXPERIENCE 1 Have yu had a part-time jb? ( ) YES ( ) NO If yes, please describe what yu did and where yu wrked: 2 Write a brief statement setting ut clearly why yu have chsen this qualificatin and hw yu intend t use it after graduatin: 3 Hw did yu find ut abut this bursary? ( ) SIOC-cdt Advertisement ( ) Family / friends ( ) Schl / Teacher ( ) Internet ( ) SIOC-cdt Website I declare that the infrmatin supplied in this applicatin is t the best f my knwledge true and crrect. I understand that any false infrmatin will autmatically disqualify me frm btaining any funding and culd further lead t me being charged in a Curt f Law fr fraudulently receiving funding. SIGNATURE PLACE DATE SIOC-cdt 2018 Bursary Applicatin Frm