EXTERNAL BURSARY APPLICATION FORM

Transcription

1 EXTERNAL BURSARY APPLICATION FORM Mtema Mashao Consulting Engineers Bursary Application Form Page 1

2 INSTRUCTIONS REGARDING THIS BURSARY FORM It is not for company employees Use block letters to complete the application form Give concise answers and where applicable mark with X Attach certified copies as required. Incomplete or late applications will not be considered Applications should be forwarded to: HR Manager Mtema Mashao Consulting Engineers (Pty) Ltd P.O. Box 78 Nelspruit 1200 How did you know about our bursary? Newspaper University staff Friend Website Career awareness Other, specify Mtema Mashao Consulting Engineers Bursary Application Form Page 2

3 A. PARTICULARS OF APPLICANT Title:. Surname: First names:. Male Female Identity number Race African Asian Coloured Indian White Nationality Province Disability (If yes, attach proof.) Yes No Marital status. Home language.. Postal Address. Residential Address Postal code: Postal code: Cellphone no.:. Tel. no. (h):. Tel. no. (w): Fax. no.:. Mtema Mashao Consulting Engineers Bursary Application Form Page 3

4 B. PARTICULARS OF UNDER / POSTGRADUATE FOR WHICH YOU WISH TO RECEIVE BURSARY DIPLOMA B-TECH DEGREE MASTERS DOCTORATE Student Number (if available): At which university / institution: Obtained admission: YES (If yes, attach proof) NO Field of study: Major / main subjects: Mark the academic year for which you are applying: Short description or title of proposed research project (Masters Students only) Details of the research proposal: Indicate the problem statement and the importance of your study (research) to society. Mtema Mashao Consulting Engineers Bursary Application Form Page 4

5 C. EDUCATIONAL QUALIFICATIONS National Senior Certificate: Year obtained: Aggregate symbol: Name of School: Results (if still in Grade 12, attach Grade 11 examination results): Subject Symbol / Marks obtained List all the diplomas / degrees obtained, including the present degree Degree / Diploma First registration Year obtained Full time / Part time Name of Institution If you are not currently enrolled at an educational institution, please indicate what you are doing at present.... Mtema Mashao Consulting Engineers Bursary Application Form Page 5

6 D. OTHER BURSARIES, SPONSORS AND/OR DONORS Do you presently study with a bursary? YES / NO If yes, what is the name of the bursar? Annual value of the bursary Obligations of the bursary Father s occupation Mother s occupation Guardian s occupation Mark your father s monthly income group: < R5 000 R R R R >R (Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.) Mark your mother s monthly income group: < R5 000 R R R R >R (Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.) Mark your guardian s monthly income group: < R5 000 R R R R >R (Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.) How many other dependents are still at home/. Number of dependents at tertiary institutions. Number of dependents still at school Do you have or have you received a study loan? YES / NO If yes, name of loan. For what purpose. When did you get it?... For how long are you intending to use it?... How do you intend to repay it?... If your bursary application is unsuccessful, what other options would you consider?... Mtema Mashao Consulting Engineers Bursary Application Form Page 6

7 E. DETAILS OF PARENTS / GUARDIAN / NEXT OF KIN Title:.. Surname:. Names: Identity No.: Relationship: Mother Father Other, specify Postal Address. Residential Address Postal code: Postal code: Cellphone no.:. Tel. no. (h):. Tel. no. (w): Fax. no.:. Mtema Mashao Consulting Engineers Bursary Application Form Page 7

8 F. MOTIVATION WHY YOU MUST BE CONSIDERED FOR BURSARY Mtema Mashao Consulting Engineers Bursary Application Form Page 8

9 G. DOCUMENTATION Please attach certified copies of the following: Identity document of the applicant. Driver s license is not acceptable. Certificate of qualifications Recent academic records or school results Confirmation of registration or Admission letter Family income or an affidavit if parents are unemployed. Not required if parents are employed by Mtema Mashao Consulting Engineers. Research proposal (Masters students) H. DECLARATION I hereby declare that the information provided in this application is correct and true in every respect. I am aware that failure to render correct information will lead to my application being disqualified. Therefore should I be awarded a bursary, I will abide by the regulations applicable. Signature of applicant.. Date. If minor, signature of parent / guardian. Date. Mtema Mashao Consulting Engineers Bursary Application Form Page 9