Surname of Applicant.. Attach First Names I D Photo here

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1 a project of the P O Box 440 Mandini 4490 (032) Fax (032) Please read the following before filling in the application form The Brotherhood of Blessed Gérard has a limited amount of money, which has been donated towards better education for people who the management committee deem to be the neediest and qualify academically to further their studies. The fact that you have received an application form does not mean that you automatically qualify for a bursary. The management of our organisation will make this decision. Although this grant is paid to the educational institution on behalf of the student, it is the student's responsibility to furnish the management committee with his/her results on a regular basis. Your application will not be considered if you have not applied for a bursary elsewhere. The Brotherhood of Blessed Gérard also strongly requests that the recipient, upon completion of his/her studies should contribute towards Blessed Gérard s Bursary Scheme, to enable others who come after them to have the same chance. Should you receive a bursary for one year, you need to reapply before the end of the current year for the next year. The closing date for all applications is 31 st December. Any application received after this date will not be considered Please deliver this form personally to the office of the Brotherhood of Blessed Gérard at 61 Anderson oad, Mandeni. Surname of Applicant.. Attach First Names I D Photo here Date of Application. For office use only Date application received Date bursary approved / declined. Amount approved Bursary approved by.

2 Section A. (To be completed by all applicants) Surname First Names Date of Birth: APPLICANT S PESONAL DETAILS Where were you born (Town & Country) Identity number Nationality esidential Address Postal Address (If different from above) Telephone Code & Number. Section B. PAENTS/GUADIAN'S DETAILS (To be completed by applicants who are dependant on their parents or who are minors) Father s / Guardian s full names Address Telephone code & number Employer Telephone code & number of employer How long has he / she worked there? Number of children under the age of 18 Ages Father s/guardian's income per month (including overtime, bonuses etc) Mother s Income per month (including overtime, bonuses etc) Total of Household Expenses per month (ent, Electricity, food, etc)

3 Section C. EDUCATIONAL BACKGOUND (to be completed by all applicants) Name of institution which you presently attend Town Province What grade are you in Name your school subjects, your latest results and which level e.g. Higher grade, Standard Grade Subject Symbol Level Subject Symbol Level Give details of your past studies in a university or college. (Please supply copies of your latest results.) Give details below of any other formal education or qualifications, which you have. Section D GENEAL INFOMATION (To be completed by all applicants) What course would you like to study in the forthcoming year? Name of University, College or school which you would like to attend Have you been accepted by this institution. If yes provide copy of acceptance letter & fees. What year or grade would you qualify for? Give reason for requesting financial assistance. yes no Why have you chosen to study this course?

4 What subjects will you study in the forthcoming year (please give details below) Name of other bursaries applied for. What reply have you received from them? Section E. FINANCIAL DETAILS OF THE BUSAY, WHICH YOU AE APPLYING FO. Education fees per year esidence fees per year Books per year Other (Please explain in detail) Total Section F. EFEENCES Names of persons prepared to recommend you to study this course (Not a family member) 1. Title, first name & Surname Postal address Telephone code & number 2. Title, first name & Surname Postal address Telephone code & Number DECLAATION I have read all the information and understand it. I confirm that the above information is true and correct. I will accept the final decision of the Management Committee of the. Signed on. Day of 19.. Applicant's signature

5 Check List Before delivering your application, make sure that you have attached the following: 1. A certified copy of your I.D. Book (If you are under 16 years please supply a copy of your birth certificate.) 2. A recent photograph of yourself. 3. A certified copy of your latest examination results. 4. A certified copy of your matric certificate. 5. A certified copy of at least two recent testimonials. 6. Proof of application for other bursaries. 7. Proof of acceptance to educational institution where you have applied. 8. An official list of fees for the above institution. 9. Any other information, which you think, will help to make a decision in your favour. For office use only Amount of bursary granted per year for 1 st for 2 nd for 3 rd for 4 th Fees paid esidence pd Books paid Other paid Total paid Amount Date