CLOSING DATE / SLUITINGSDATUM: 15 December 2017 APPLICATION FORM / AANSOEK VORM ISAAC JOFFE FELLOWSHIP BURSARY SCHEME APPLICATION FOR A GRANT AANSOEK OM TOEKENNING NAME OF APPLICANT NAAM VAN AANSOEKER All correspondence should be addressed to: Alle korrespondensie moet gerig word aan : The Secretary Kushlick/Kaplan Bursary Scheme P O Box 54 Vanderbijlpark 1900 Die Sekretaris Kushlick/Kaplan Beursskema Posbus 54 Vanderbijlpark 1900 TEL. NO. [016] 980 2399/2237
INSTRUCTIONS / INSTRUKSIES Read these notes carefully before you complete the application form / Lees die notas noukeurig voor die voltooing van die aansoekvorm. 1. Make sure that you read every section and that the information you provide is accurate. / Maak seker dat jy elke gedeelte noukeurig deurlees en dat die inligting wat jy verskaf akkuraat is. 2. Proof of matric and 1 st year academic results needs to accompany the application form. / Bewyse van matriek uitslae asook 1ste jaar akademiese resultate moet die aansoekvorm vergesel. 2
PART 1 / DEEL 1: Surname/ Van First names / Voorname Identity number/ Identiteitsnommer Date of Birth/ Geboortedatum Marital status / Huwelikstatus Home address/ Huis adres Postal code/ Poskode Telephone number/ Telefoonnommer PERSONAL DETAILS / PERSOONLIKE INLIGTING Age/ Ouderdom Sex/ Geslag Postal address/ Posadres Postal code/ Poskode PART 2 / DEEL 2: PARENTS / GUARDIAN INFORMATION / OUERS/VOOG INLIGITNG A. Name of father / guardian Naam van vader/voog Identity number/ Identiteitsnommer Employer of father/guardian Werkgewer van vader/voog Telephone number/ Telefoonnommer B. Name of mother/guardian Naam van moeder / voog Identity number/ Identiteitsnommer Employer of mother/guardian Werkgewer van moeder/voog Telephone number/ Telefoonnommer 3
PART 3 / DEEL 3: ANNUAL INCOME CATEGORY / JAARLIKSE INKOMSTE KATEGORIE Number of income earners per family/ Aantal inkomste-verdieners in familie None Geen One Een Two Twee Three Drie Four Vier 4 Estimated gross income per month /Geskatte bruto familie inkomste per maand ( Mother & Father income) ( Moeder & Vader inkomste) R45001 R35001 20001- A - B - C D R70000 R45000 R35 000 R70001 and above 0 - R20000 E PART 4 / DEEL 4: ACADEMIC HISTORY OF APPLICANT / AKADEMIESE GESKIEDENIS VAN AANSOEKER NAME OF SCHOOLS ATTENDED / NAAM VAN SKOLE BYGEWOON NAME OF SCHOOL YEAR GRADE FROM TO COMPLETED Attach proof of matric results / Heg matriekuitslae aan PART 5 / DEEL 5: TERTIARY EDUCATION / TERSIêRE OPVOEDING A) CURRENT Name of University / Technikon: Currently registered in academic year of study. Student number: Degree: 1 st 2 nd 3 rd 4 th 5 th Year commenced: B) PREVIOUS Have you previously attended University YES NO Name of University: Student number: Degree studied: Year commenced: 4
Have you repeated any year of study during your current or previous tertiary studies? If yes, state year, date and reason: YES NO 1 st year of study Subjects June % Obtained Dec Attach proof/ Heg bewys aan PART 6 / DEEL 6: ADDISIONAL PERSONAL INFORMATION / ADDISIONELE PERSOONLIKE INLIGTING Please supply information about your interests in: Extra mural activities Community activities 5
Please state your: Interests Hobbies Write a brief statement setting out clearly why you have chosen these studies/career: PART 7 / DEEL 7: OTHER INFORMATION / ALGEMENE INLIGTING Do you currently have a scholarship, bursary or loan? Yes No If yes, what is the name of the award? Who has it been awarded by? What is the value of the award? Is there a service obligation attached to the scholarship, bursary or loan? Yes No Have you been employed since leaving school? Yes No Part Time Full Time 6
PLACE OF RESIDENCE / PLEK VAN VERBLYF Hostel / Koshuis Parents / Ouers Private / Privaat Please specify if not with parents/guardian/ Spesifiseer indien nie by ouers / voog nie: Adress / Adres Postal code / Poskode Telephone number / Telefoonommer DECLARATION / VERKLARING I declare that the above information is to the best of my knowledge accurate and I understand that any false statement renders me liable to instant disqualification. Furthermore, I undertake to conform to all rules and regulations which may be in force from time to time should I be successful to obtain a bursary. Ek verklaar dat bostaande inligting na die beste van my wete juis is, en ek aanvaar dat enige vals verklaring my blootstel aan onmiddellike wegwysing. Verder onderneem ek, indien ek suksesvol is om 'n beurs te ontvang, my te onderwerp aan die reëls en regulasies wat van tyd tot tyd van krag mag wees. Signature Applicant / Handtekening Aansoeker Date / Datum 7
A family company, which has always valued its self-reliance. Cape Gate (Pty) Ltd has, through vertical integration, grown from a small wire netting manufacturing company in 1962 to a major producer of wire and steel products. The factory is situated in Vanderbijlpark, Gauteng. Objectives and Scope of the Bursary Scheme The objectives of the bursary scheme are to provide educational assistance for prospective candidates for engineering degrees. The scheme shall provide bursaries from 2 nd year engineering degree students at approved universities in South Africa for, Electrical and Chemical Engineering. Extent of assistance The value of bursaries will be defined from time to time, and will be based on the cost of: Full tertiary registration and tuition costs Residence fees that include meals, or if the bursar chooses to live privately, a generous living out allowance. Book allowance A personal allowance for the period that the bursar is at the tertiary institution. A once-off computer allowance. Bursary Allocation Criteria Bursaries will be allocated on the basis of a balanced consideration of the following factors: Academic performance: Applicants will be granted a bursary only if s/he obtains at least an aggregate symbol of C or higher in her/his final first year results. Financial need Requirements of the Institution i.r.o. the specific course. A selection process including assessments and interviews.
Conditions / Obligations The granting of a bursary applies from 2 nd year full-time engineering Compulsory annual salaried vacation employment at the company during December and January is a condition for bursars. Assistance will only be provided for the normal duration of the specific course. Assistance will be provided on a year-to-year basis and bursaries will be renewed only if performance of bursars are satisfactory. At the sole discretion of Cape Gate (Pty) Ltd, the company will require bursars who obtain their qualifications to work for the company for the period that the bursar was sponsored at a tertiary institution. This period will be paid for at market rates. Should bursars choose not to meet this obligation, the bursar will be required to reimburse the company for all monies spent on the tertiary studies, plus interest. How to apply and enquiries Applicants will be required to complete the official bursary application form, obtainable from the Human Resource Development Department, Cape Gate (Pty) Ltd. Enquiries can be directed to Mrs. Rina Oosthuizen (016) 980 2399 or Nthabiseng Kubeka (016)980 2464 Completed application forms should be returned to the Human Resource Development Department Cape Gate (Pty) Ltd. by 15 December 2017. The completed application forms can be faxed to (016) 980 2225, or emailed to kubekan@capegate.co.za or oosthuzr@capegate.co.za. The selection for the new applicants will commence thereafter. In cases where bursaries are not approved, the applicants will be notified in writing. 2