W&RSETA BURSARY APPLICATION FORM

Transcription

1 W&RSETA BURSARY APPLICATION FORM NB: Please Complete All Sections of the Application Form in Full. Applications Received after the closing date (17 February 2017) will not be considered Applications must be accompanied by supporting documents (refer to section I of the Application form) Applications must be ed to: bursaryapplications2017@wrseta.org.za Were you previously awarded a bursary by W&RSETA Yes No Have you been accepted at the TVET College or Institution for 2017 academic year Yes No Have You Matriculated Yes No Name of High School Yes No Year Obtained Yes No ID Number A. PERSONAL DETAILS Title Mr Mrs Ms First Name Initials Surname Date of birth Gender Male Female Equity Black Coloured Indian White Home Language Nationality Citizen Residential Status South African Permanent Resident Dual Resident (SA +other) Socio Economic Status Unemployed Employed Telephone Number Fax Number: Cell Phone Number Address POSTAL ADDRESS Postal Address District Municipality Province PHYSICAL ADDRESS Physical Address District Municipality Province Is your Area Rural or Urban: Rural Urban W&RSETA BURSARY APPLICATION FORM 2017 Page 1 of 5

2 B. PARENT OR GUARDIAN DETAILS ID Number Title: Mr Mrs Ms Dr Prof Adv First Name Initials: Surname Cell Number Date of Birth Address Gender Male Female Equity Black Coloured Indian White Home Language Relationship to Applicant Nationality Marital Status Single Married Widowed Divorced Socio Economic Status Employed Unemployed C. PARENT OR GUARDIAN EMPLOYER DETAILS Name of Employer Employer address Physical Code D. PARENT OR GUARDIAN INCOME DETAILS Source of Income: Salary Wages Self Employed Pension Social Grant Social Grant Number Gross Household Income (per month) Number of Dependents Disposable Income (per month) E. STUDY DETAILS Bursary Application for : TVET College University of Technology University Have you been accepted: Yes No Name of TVET College : Name of TVET College Campus F. STUDY DETAILS FOR TVET COLLEGES (Complete this section if you are accepted or registered at a TVET College) Region (Where the TVET College is located e.g. Centurion) Province (Where TVET College is located e.g. Gauteng) Student Number: Study Course (e.g. N6 Financial Management) Field of Study or Discipline (e.g. Financial Management) Year of Study in 2017 N4 N5 N6 NCV level 2 NCV level 3 NCV level 4 Expected Year of Completing the Studies (e.g. 2018) Duration of the Qualification 3 Semesters 4 Semesters 3 Years Qualification Type Nated N6 NCV level 2 NCV level 3 NCV level 4 W&RSETA BURSARY APPLICATION FORM 2017 Page 2 of 5

3 Name of Institution G. STUDY DETAILS FOR UNIVERSITY OF TECHNOLOGY OR UNIVERSITIES (HET) (Complete this section if you are accepted or registered at a HET) Name of Campus Region (Where the University is located e.g. Pretoria West) Province (Where the University is located e.g. Gauteng) Student Number Study Course Field of Study or Discipline Year of Study in st Year 2 nd Year 3 rd Year Expected Year of Completing the Studies (e.g. 2019) Duration of the Qualification 3 Years 4 Years Qualification Type Degree Diploma H. ACCOMMODATION Accommodation Status Residing at Home Residing at TVET College / University Accommodation Are you staying or will you be staying at TVET College/ University residence or Accredited/ Leased/ Contracted student accommodation: Yes No If you ticked yes above, Name of Accommodation I. FEE COST BREAK DOWN Registration Fee Tuition Fee (include First and Second Semester fees) Accommodation if applicable: Book Allowance Meal Allowance (Cannot exceed R per annum) TOTAL J. CHECKLIST FOR SUBMISSION OF SUPPORTING DOCUMENTS REQUIRED (Your application must be accompanied by the following documentation listed below. Application Forms with incomplete supporting documents will not be considered) Certified Copy of South African ID Statement of Results /academic record Proof of admission or proof of registration Statement of fees Proof of accommodation if staying in residence and not reflected on the statement of fees Proof of Parent or Guardian s Income W&RSETA BURSARY APPLICATION FORM 2017 Page 3 of 5

4 DECLARATION OF AUTHENTICITY I declare that the information supplied in this application is to the best of my knowledge true and correct. I understand that any false information will automatically disqualify me from obtaining any funding and could further lead to me being charged in a Court of Law for fraudulently receiving funding. Signed at on this day of 2017 Signature W&RSETA BURSARY APPLICATION FORM 2017 Page 4 of 5

5 FOR OFFICE USE ONLY APPLICATION NO. DATE RECEIVED APPLICATION REVIEW DATE OUTCOME OF APPLICATION : Accepted Declined PLEASE RETURN THE APPLICATION FORM VIA bursaryapplications2017@wrseta.org.za OR DELIVER AT YOUR NEAREST W&RSETA OFFICES W&RSETA BURSARY APPLICATION FORM 2017 Page 5 of 5