Application for a Bursary for Year 2018 Please read the following before filling in the application form 1. Khulisa Academy has a limited number of bursaries, which have been made available to people who the Academy deems to be the most suitable and who qualify academically to broaden their skills set and academic knowledge in the Information Technology Sector. 2. The fact that you have submitted an application does NOT mean that you automatically qualify for a bursary. The management of our scholarship programme will make this decision. 3. Only South African citizens will be considered 4. This form MUST be completed in all respects. 5. All relevant documents as requested in the checklist MUST be attached to your application. 6. All family income to be disclosed and substantiated in full. 7. Your application will NOT be considered if you already hold a scholarship/bursary from another company or organization. 8. All successful bursary recipients will be required to sign a contractual agreement. 9. Please submit completed application forms to the Khulisa Academy. Surname Year of Study Year-end average Gross earnings of Household per annum First name Citizenship Date of Application Attach ID Photo FOR OFFICE USE ONLY: Date Application received Amount Approved Date Approved/ Declined Bursary Approved By
Section A: Applicant s Personal Details Surname First Names Date of Birth Identity number Age Where were you born? (Town & Country) Nationality Disability (if applicable) Any Health conditions? Criminal record? Residential/Home address Home Telephone code & Number Cell phone Number 1 Cell phone Number 2 E-mail Address
Section B: Parents /Guardians Details Guardian: FATHER MOTHER Surname First Names Date of Birth Home Address Home Telephone code & Number Occupation Employer Employer phone number Duration of employment (months/years) Number of children under the age of 18 Ages Number of post matrics in the house Gross Income per month Total household expenses per month Total Family gross income per month
Section C: Educational Background Name of High School or University which you presently attend Town/City Province What year are you in Student no. Student Motivation Please provide motivation of why you should be considered for the program? Include the following: What is your greatest passion, your strengths, your major weaknesses, achievements so far? If you need more space please use additional page at the end of this form.
Section D: References Names of persons prepared to recommend you to study this course (not a family member) 1. Title, First name & Surname Occupation Telephone code & number Address 2. Title, First name & Surname Occupation Telephone code & number Address Declaration by Applicant I hereby confirm that I have read and attached all applicable documents as listed in the checklist which accompanied the issue of this application form. I have read the information and understand it. I understand that my application form WILL NOT be considered unless the form is fully completed and all the requested documents are attached. I agree that Khulisa Academy and its bursary administration may confirm the details I have provided. I confirm the above information is true and correct. I will accept the final decision of Khulisa Academy. SIGNED ON THE DAY OF 201_. APPLICANTS SIGNATURE
Section E: Application Checklist NAME STUDENT NUMBER Before sending your application, use this checklist to make sure that you have completed your application and attached all the required document Incomplete Applications will not be considered. DOCUMENTATION: 1. A certified copy of your South African ID document or passport. 2. A recent photograph of yourself. 3. A certified copy of your latest examination results 4. A certified copy of your matric certificate (when available) 5. If your parents or guardians are deceased or divorced provide a copy of death certificate or divorce decree (including details of any maintenance payments) 6. If your parents or guardians are unemployed a sworn affidavit signed by the unemployed person before a commissioner of oaths proving unemployment must be provided 7. If your parents or guardians are employed provide the most recent pay slip for each person, giving full details of gross income and all other benefits 8. If either of your parents or guardians are pensioners a certified copy of their pension slip must be provided 9. If either of your parents or guardians work in the informal sector or own any business provide an audited financial statement or sworn affidavit indicating estimated gross monthly income. Send the application form and all documentation to: applications@khulisaacademy.co.za. Closing date is 29 July 2017. PLEASE ENSURE THAT ALL DOCUMENTATION IS ATTACHED IN THE E-MAIL ALONG WITH THIS FORM.