1 Siyakha 1 Education Trust Bursary Application Form INSTRUCTIONS 1. Ensure every section of the Bursary Application Form is read and the information which is provided is accurate. 2. The application form must be completed in English. 3. Handwritten applications must be completed using block lettering, in black ink. 4. An application form will not be considered if the applicant does not include the following documents: a certified copy of their ID, a motivational letter (+-500 words) and their latest academic record. 5. Incomplete or illegible application forms and / or supporting documents will not be considered. 6. Completed application forms and all supporting documents must be submitted to: ibhasari@siyakha-trust.co.za before 17h00 on 31 August 2017. NOTES 1. The bursary is only awarded to South African citizens with a valid South African ID number. 2. Grade 12/ Matriculants must have a minimum average of 70% for First Language English and 80% minimum pass rate for Additional Language English. 3. Grade 12 / Matriculants must have an 80% minimum pass rate for Math, Physical Science or Accountancy. 4. The bursary applicant must already be accepted at one of the accredited public universities, the Siyakha 1 Education Trust awards bursaries for. 5. The universities are: The University of Pretoria, University of Witwatersrand, University of Johannesburg, University of the North West (Potchefstroom), University of the Free State, University of Cape Town, University of Stellenbosch, Rhodes University and University of Kwa-Zulu Natal. 6. The bursary covers the following costs: full tuition, university registration, university residence, text books, stationary and a monthly allowance. 7. Applicants are expected to have an e-mail address and a cell phone contact number for communication purposes. 8. The Bursary Committee meets and processes all bursary application forms. Successful applicants will be notified before 1 October. 9. Any bursary awarded is subject to the condition that the applicant s end of year results in Grade 12, does not differ substantially from the results presented during the application process. 10. The Siyakha 1 Education Trust reserves the right to withdraw the bursary offer if the applicant performs substantially weaker academically, than the academic performance presented during the application process. 11. Successful bursary applicants will be required to write the National Benchmark Test (NBT). Applicants will cover the costs to write the test from their own account. On proof of payment and completion of the test, the applicant will be refunded the costs with their first allowance payment when they are at university.
2 Section A General Information of Applicant Title: MR / MRS / MISS Full name: Surname: Age: ID number: Gender: M / F Date of birth: / / Nationality: RSA / OTHER specify: Population group: AFRICAN / COLOURED / INDIAN / WHITE / OTHER Specify: Home language: Contact number: E-mail address: Physical address: Postal address: Do you suffer from any chronic disorder or physical handicap? Y / N If yes, please provide details: Have you been convicted of any crime(s): Y / N If yes, please provide details: In case of emergency: Name of guardian: Relationship: Contact number: 1. 2.
3 Section B Secondary Educational Information School currently attending: Telephone number of school: Principal name and surname: Principal contact details: Physical address of school: Official school stamp If any other Secondary schools were previously attended please complete the following: Name of school Start date End date If you are currently in Grade 12, submit your most recent academic record and complete the below table. **Please note that your latest report card needs to be attached for confirmation. Subjects Grade 10 % Grade 11 % Grade 12 % Extramural activities, sports participation and/or community activities: Name of activity/sport Level (National/Provincial/School team) Achievements
4 Section C Tertiary Educational Information State the career you wish to follow: Have you applied to a University: Y / N If yes, name(s) of the institution(s): 1. **If you have applied to more than one University, please complete the following: 2. 3. Are you currently studying at a University: Y / N If yes, what is the field of study: Current academic year of study: Section D - Declaration I (full name) confirm the information contained in this application is, to the best of my knowledge, correct and truthful. I understand if it is not, I may be eliminated from consideration in the selection process. If, after being admitted to the Siyakha 1 Education Trust Bursary Fund, any falsehoods or omissions are discovered in my application, I understand my application may be not be considered. I understand all statements in my application may be investigated. I authorize the Siyakha 1 Education Trust to contact the following person or people who might be able to speak about my abilities and suitability, for the bursary for which I have applied:
5 I (full name) understand an investigation of my application will include reference checks from my school and or other institution listed on my application form. I authorize the responsible person representing these establishments to provide the Siyakha 1 Education Trust with relevant information and opinions which may be useful in making a decision, and release such persons and organizations from legal liability in making such statements. (Please specify persons/institutions you would like us to contact.) Signature of Applicant: Date: OFFICE USE ONLY Date application was received Nearest shopping centre name Province of application Siyakha representative Medium application was received Application is filled in correctly Motivational letter Academic record Certified ID document Academic criteria Comments: