INDEPENDENT DEVELOPMENT TRUST EXTERNAL BURSARY FORM

Transcription

1 WHAT IS THE PURPOSE OF THIS FORM To assist the Independent Development (IDT) Trust in selecting candidates for the IDT bursary scheme This form may be used to identify candidates to be interviewed Since not all applicants can be interviewed, you need to fill in this form completely, accurately and legibly. This will help to process your application fairly. WHO SHOULD COMPLETE THIS FORM Only candidates wishing to apply for a bursary in the study fields stated below ADDITIONAL INFORMATION REQUIRED Cover letter stating why you should be considered for a bursary Certified copy of ID Certified copies of full official academic transcripts Proof of provisional acceptance at institution (where applicable) Proof of parent s income statement/ salary advice NOTES: This document is not in any way an agreement or commitment The selection of learners is totally dependent on excellent results obtained and the outcome of the selection process All applications to reach the Independent Development Trust by 10 January 2011 Only South African citizens can participate in this scheme Note: No late applications will be accepted Page 1 of 9

2 PART A: ACADEMIC INFORMATION Please state the degree you will be pursuing *STUDY DISCIPLINE BUILDING SCIENCE TOWN AND REGIONAL PLANNING CIVIL ENGINEERING DEVELOPMENT ECONOMICS DEVELOPMENT STUDIES COMMUNITY DEVELOPMENT *only qualifications with these major subjects will be considered MARK WITH X Page 2 of 9

3 PART B: PERSONAL INFORMATION Name ID Numbers Surname Date of Birth *Gender Male Female Race African White Coloured Indian Do you have disability Yes No Are you a South African Citizen Yes No If no, what is your nationality Have you ever been convicted of a criminal offence? Yes No If Yes give details: Have you applied to any other institution for bursary? Yes No PART C: CONTACT DETAILS Contact Numbers Cell: Alternative: Postal Address Address Page 3 of 9

4 PART D: EDUCATIONAL PARTICULARS (PLEASE COMPLETE IN FULL) Secondary Education (Please provide copy of certified matric results) Name of Institution Highest qualification obtained Subject Symbol Tertiary Education Name of Institution Degree/Diploma Major Subjects Year Obtained Page 4 of 9

5 PART E: PARTICULARS OF THE DEGREE FOR WHICH YOU WISH TO RECEIVE A BURSARY Please mark the level of qualification with an X 1 st Degree Honours Masters Doctorate At which University/Institution do you wish to study Degree you wish to pursue Major Subjects Mark the academic year for which you are applying (Please mark with an X) Have you been provisionally accepted at the University (Please provide proof) Do you intend staying at the University residence? What is the estimated cost of your studies per annum What is the estimated cost for the residence per annum If you are not currently enrolled at the University/Institution and have completed matric, please indicate your current activities Page 5 of 9

6 PART F: FAMILY CIRCUMSTANCES Do you presently have a bursary/ study loan Yes No Annual value of the bursary/study loan Please describe any obligations/contracts you may have with your sponsor Father s Occupation Mother s Occupation Guardian s Occupation Mark your father s monthly income (attach proof) R0 -R2500 R2500 R5000 >R5000 Mark your Mother s monthly income (attach proof) R0 -R2500 R2500 R5000 >R5000 Mark your Guardian s monthly income (attach proof) R0 -R2500 R2500 R5000 >R5000 How many dependants are still at home? How many dependants are still at tertiary institutions? How many dependants are still at school? Page 6 of 9

7 Do any of your parents/guardian work for the IDT Should your parents be unemployed or work for an employer where there is no salary advice, kindly furnish an affidavit to that effect. Page 7 of 9

8 PART G: DECLARATION I understand that all the information provided in my application may be followed up and I authorise the IDT to contact any relevant person or institution for relevant references 1. I declare that the above information to my knowledge, is true and correct and accept that if it were to be found that I withheld any information, my application will be cancelled immediately 2. I authorise any school/ University/ Employer to provide the IDT with relevant information that may be useful in making a decision Signature of Applicant Date: Signature of Parents/Guardian, if still a minor Date: Page 8 of 9

9 0FFICE USE ONLY Captured Date: Comments: Interview Regret Other Signature Page 9 of 9