Choice 2: Choice 2: Choice 1: Choice 2: INDICATE THE CAMPUS/SITE WHERE YOU WANT TO STUDY. Mark with X NELSON MANDELA DRIVE CAMPUS/SITE SITE SITE

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1 2015 Application for Admission REFERENCE NO: Instruction: request for Reference no. to any of the addresses provided hereunder. Closing dates and applicable fees Please note: The closing date for applications for Faculty of Health Science programmes is the 30 September No late applications are accepted thereafter. A non-refundable application fee must accompany application: The closing dates and applicable fees for programmes in other faculties are the following: Before and up to 30 September 2014 R100-00, 01 0ctober - 30 November 2014 R200-00, thereafter R Pay application fee into WSU Account at First National Bank, Account no: Branch no: USE REFERENCE NO when paying application fee at the bank. OFFICE USE: STUDENT NUMBER SECTION A: INDICATE THE PREFERRED COURSES OF STUDY. Mark with X FT PT Undergraduate Choice 1: New Applicant Study Choice 2: Postgraduate Study Choice 1: Choice 2: FT Undergraduate Choice 1: International Study Choice 2: New Applicant Postgraduate Choice 1: Study Choice 2: INDICATE THE /SITE WHERE YOU WANT TO STUDY. Mark with X DELIVERY POTSDAM COLLEGE CHISELHURST IBIKA NELSON MANDELA DRIVE /SITE SITE STREET SITE SITE SITE SITE ZAMUKULUNGISA QUEENSTOWN SITE Have you ever studied at any of these institutions before? UNITRA Eastern Cape Technikon Border Technikon If YES, provide student number STUDENT NUMBER PT SECTION B: MTHATHA Send completed application form to the campus/site of your choice. Choose ONE Address: Postal address or address or Fax 2 . NB: Keep Proof of Payment Safe. Nelson Mandela Drive and Zamukulungisa sites Postal Address: Address: Fax 2 Private Bag X1 Mthatha, 5117 Tel: /2448/2851 nmdadmiss@wsu.ac.za BUFFALO CITY Potsdam, College Street and Chiselhurst sites Postal Address: Address: Fax 2 Private Bag X1421 East London, 5200 Tel: /5223 bcadmiss@wsu.ac.za BUTTERWORTH QUEENSTOWN Ibika site Masibulele College- Whittlesea site Postal Address: Address: Fax 2 Postal Address: Address: Fax 2 Private Bag X3182 Butterworth, 4960 Tel: /6267 ibikaadmiss@wsu.ac.za P.O.Box 876 Queenstown, 5320 Tel: /6803 queenadmiss@wsu.ac.za SECTION C: Personal Information Mr/Mrs/Miss/Dr/Prof Surname Initial(s) First Name(s) Maiden name (if applicable) Date of Birth DD MM YYYY SA Identity document number. (Only) Gender & Race Male Female Black White Coloured Indian Other Marital Status Married Divorced Widowed Single Nationality SA citizen If not SA citizen, indicate citizen status from below: (A) African (African country) (F) Foreign (outside Africa) R) Refugee Page 1

2 (E) Exchange student (N) Permanent resident Passport number Study permit no. Date of Expiry DD MM YYYY SECTION D: Contact details (Compulsory). Your application cannot be processed without this information. Postal Address Postal Code Province if residing in SA Telephone no. Code - Cell phone no. Address Physical Address (Street or Administrative Area) SECTION E: Parent or Next of Kin information. Surname Initial(s) Full name(s) Relationship Parent (Mother) Parent (Father) Next of Kin Postal Address Address Home Address/Physical Address Postal Code SECTION F: Current activity: What are you doing this year, 2014? High School Studying University Studying College Nursing College Other, specify SECTION G: Physical limitation(s) - Confidential WSU is sensitive to challenge(s) and limitation(s). In order to provide you with the necessary services, you need to indicate your disability status at the time of your application. If you do not inform us WSU cannot undertake to provide assistance. Every reasonable attempt will be made to provide you with the assistance you may need as a result of your disability. Are you physically challenged? Yes No If YES, please specify below: Blind or Partially sighted Hearing problem or even wearing hearing aid Communication (talking/listening) Physical (moving, standing, grasping) Intellectual (difficulty learning) Emotional (behaviour / psychological) Other(s) not mentioned above, please USE a separate sheet to explain. SECTION H: Post School Academic Activities Qualifications obtained: Attach certified copy(s) of certificates obtained after you passed matric or grade 12 to this application form. If you want to apply for exemption for course(s)/modules from another institution, consult the Faculty Office for application form. SECTION J: Current year Grade 12 school children/adults Attach certified copy of your June 2014 Grade 12 results to this application form. SECTION K: Declaration by the Applicant and Parent/Guardian: Applicant: 1. I declare that all particulars given by me on this application form are true and correct. 2. I agree that any misrepresentation due to the information provided on this form or the withholding thereof shall cause this application to become null and void at the discretion of the University without prejudice to its rights. 3. If my application is successful, I undertake to: a. Comply with the rules and regulations of the University. b. Inform Registrar immediately in writing of any change of address by me. c. Acquaint myself with the rules and general regulations relating to the programme to which I am admitted. 4. I am fully aware that the University is under no obligation to provide with either financial assistance or accommodation. 5. I acknowledge that all fees have been determined by the Council of the University. 6. I agree that the relevant fees will be paid as indicated in the rules/prospectus of the University. If such fees are not paid, I acknowledge the rights of the University to cancel my registration at any time and demand payment of the amounts owing by me and/or my Parents or Guardian. 7. Should, during the course of my studies at the University, sustain any injuries or contract any illness or suffer any loss or damage, I undertake not to institute any claim against the University on account thereof, irrespective of the cause of such damage or loss. In the event of my death during the course of studies, this undertaking shall be binding on the executor of my estate and my heir and successorin-title. Under the circumstances referred to above, I or executor, administrator, heir(s) and successor-in-title hereby indemnify the University in respect of any damage(s) suffered by me arising from any causes referred to above. Page 2

3 Signature of Applicant Date Place Parent/Guardian: I, Mr/Mrs/Miss/Dr/Prof hereby grant permission for the declaration and undertaking made by the applicant, and I accept joint and several liability as co-principal debtor with the applicant for the payment of all fees due by him/her to the University. Signature of Parent/Guardian Date Place SECTION L: Do you NEED university accommodation to stay while studying next year? Yes No SECTION M: Do you NEED Financial Assistance? Yes No SECTION N: OFFICE USE ONLY FINANCE DEPARTMENT: CONFIRMATION OF PAYMENT OF APPLICATION FEE AMOUNT PAID: R DATE PAID: REFERENCE NO: PAYMENT CHECKED BY: SURNAME: INITIAL(S): OFFICE STAMP SIGNATURE: SECTION P: SELECTION RESULTS FOR CHOICE 1 MARK WITH X HoD: Surname: Initial(s): Signature: Date: OFFICE USE ONLY ADMITTED REJECTED PROVISIONALLY ADMITTED INVITED TO INTERVIEW/TEST Date: Time: Venue: Place: Details of Interview/Test SELECTION RESULTS FOR CHOICE 2 MARK WITH X HoD: Surname: Initial(s): Signature: Date: ADMITTED REJECTED PROVISIONALLY ADMITTED INVITED TO INTERVIEW/TEST Date: Time: Venue: Place: Details of Interview/Test COMPULSORY DOCUMENTS: Certified copy(ies) of: 1. South African identity document if South African citizen 2. Passport document if international citizen 3. Matriculation Certificate or Senior Certificate or National Senior Certificate 4. Diploma, or degree, or other post school certificates 5. South African Qualification Authority evaluation results if qualification/s obtained outside South Africa Please Mark X Page 3

4 PLEASE NOTE: WALTER SISULU UNIVERSITY FINANCIAL AID APPLICATION FORM 2015 ACADEMIC YEAR CLOSING DATE (currently registered students): 30 SEPTEMBER 2014 CLOSING DATE (first time entrants to WSU): 30 NOVEMBER 2014 NO LATE APPLICATIONS WILL BE ACCEPTED Only South African students currently registered (continuing students) or new students that have applied for, received confirmation of or provisional acceptance for admission (first-year students) can apply for financial aid. If you provide incorrect or false information on this application form, you will be disqualified and you will forfeit your NSFAS Loan. Incomplete application forms (including those with missing documents) will NOT be accepted. Only original application forms will be accepted and should be submitted at any one of the four campus Student Financial Aid Services Offices. Students can download the application form from the website or from their , and submit this as an original form. No ed or faxed documents will be accepted. If your application is approved, and you do not sign a pre-agreement quotation AND a loan agreement form OR bursary agreement form after registration, the University reserves the right to withdraw your loan/bursary funding and you will be responsible for settling your student fee account. PLEASE READ THE INSTRUCTIONS ON PAGES 5 AND 6. SIGNATURE OF APPLICANT: DATE Please read the notes and instructions in the financial aid brochure before completing the application form. FOR OFFICE USE ONLY DATE RECEIVED: NAME AND SIGNATURE OF FAO: DATE PROCESSED: NAME AND SIGNATURE OF FAO: Total Gross Income EFC value SECTION 1: STUDENT APPLICANT INFORMATION (CROSS OUT WHERE APPROPRIATE, USE PRINT LETTERS) Within N+2 First Names (as per ID document): Title: Mr / Mrs / Miss / Surname: Gender: Male / Female Marital Status: Married / Unmarried / Divorced / Widowed ID: Race: African / Indian / Coloured / White / Asian Student No: Home address (where your family lives): Home Tel No: City: Province: Postal Code: Postal Address : Postal Code: Address: Cell No: Do you have a physical disability, or a visual or hearing impairment? (If so, please ask the FAO for more information on the bursaries for persons with disabilities and the requirements for this bursary). Would you like to receive a book allowance as part of your loan? 1

5 WALTER SISULU UNIVERSITY Would you like to receive a meal allowance as part of your loan? (Value still to be determined) Has there ever been an administration order against you? (If so, please attach details) Have you ever been declared mentally unfit by a court of law? SECTION 2: 2015 STUDY INFORMATION FAILURE TO COMPLETE THIS SECTION IN FULL MAY MEAN THAT YOUR APPLICATION WILL NOT BE PROCESSED Course of Study: Degree / Diploma / Certificate Name of course: Campus: Buffalo City / Butterworth / Mthatha / Queenstown Site: In 2015, I will be a... (please mark appropriate block with a P ) 1 st time student You will be registering for the 1 st time as a student in 2015 Senior student / Continuing Student You are continuing your studies in 2015 and 2016 Final Year Student You will write your final year examinations in November 2015 to graduate in 2016 Post Graduate Student You will be registered for a Honours, Masters or Doctoral programme in 2015 In 2015 I will be in my 1st / 2nd / 3rd / 4th / 5th year of the course I am studying (circle the year of study you are in) SECTION 3: STUDENT EMPLOYMENT INFORMATION Are you currently employed (full-time or part-time): (if yes, answer all questions in Section 3) Current employer: Position: Gross Annual Income (before deductions): SECTION 4: DETAILS OF PARENTS AND/OR GUARDIAN - PLEASE COMPLETE IN FULL A. FATHER / STEPFATHER (IF LIVING WITH YOU) First Names (as per ID document): Surname: ID No: Status: Married / Single / Divorced / Deceased / Widowed (death certificate to be submitted) Gross Annual income (before deductions): Tel/Cell (Father): Tel (Employer): Any other income: Source: Amount (yr): B. MOTHER / STEPMOTHER (IF LIVING WITH YOU) First Names (as per ID document): Surname: ID No: Status: Married / Single / Divorced / Deceased / Widowed (death certificate to be submitted) Gross Annual income (before deductions) Tel/Cell (Mother): Tel (Employer): Any other income: Source: Amount (yr): C. GUARDIAN AND/OR GRANDPARENT (IF LIVING WITH YOU) Relationship: Guardian / Grandmother / Grandfather ID No: First Names (as per ID document): Surname: Status: Married / Single / Divorced / Deceased / Widowed (death certificate to be submitted) Does the guardian support the family financially? If yes, complete section in full Gross Annual income (before deductions): Tel/Cell (Guardian): Tel (Employer): Any other income: Source: Amount (yr): 2

6 SECTION 5: NEXT OF KIN INFORMATION WALTER SISULU UNIVERSITY Please select a person that the university can contact in the event of an emergency preferably a relative not residing with you. Surname: Name: Title: Address (Residential): Telephone: City: Province: Postal Code: Relationship: (Parent, legal guardian, sibling, spouse, partner, other) ID No: SECTION 6: FAMILY DEPENDENTS (FAMILY STRUCTURE) This section must be completed by one of the applicants parents or his/her legal guardian. However, if the applicant is married or has supported him/herself for more than three years, or both the applicants parents are deceased and he/she does not have a legal guardian, then the applicant should complete this section. You must list all those who are dependent on the family s total income declared in sections 3 and 4 (including parents and/or guardian). Please include yourself as the student. If you include students (other than yourself), you must submit proof that they are registered at a university or FET college. ID copies must be submitted for all persons listed below. Please refer to points 1-13 on page 6 for documents required. Name Age Identity Number Present Activities (preschool, school, student, adult) * Relation to student (parent, sibling, child, spouse, other) *If any of the persons noted above earns an income, this must be noted in the following sections: Identity Number (as above) Income source (wages, salary, pension, child support, interest on investments, business profit) Income per year ** ** Proof of income must be supplied if a person receives income from more than one source, these must all be listed. If income is from business profit, a copy of the financial statements submitted to SARS must be supplied. SECTION 7: ANY ADDITIONAL INFORMATION Is there any further information that we should know that will help us assess this application? OFFICE USE ONLY (SECTIONS 3, 4, 5 AND 6) INCOME 1: INCOME 2: INCOME 3: INCOME 4: INCOME 5: INCOME 6: INCOME 7: INCOME 8: 3

7 WALTER SISULU UNIVERSITY SECTION 8: DECLARATION BY APPLICANT/STUDENT AND PARENT/SPOUSE/LEGAL GUARDIAN Failure to complete and sign BOTH Section A and B below may result in this application not being considered. SECTION A: Declaration by the STUDENT applying for financial assistance I declare and hereby certify that, through the signing of this application form, I have made complete and accurate disclosure of my family s gross income (before deductions of tax or any other amounts). I understand that it is my responsibility to provide this information honestly and to the best of my knowledge, without prejudice. I understand that if the information provided by me is inaccurate, incomplete, not up-to-date or misleading (even if given to me in good faith and without negligence), the University or NSFAS will be entitled (in addition to instituting disciplinary procedures against me) to summarily cancel, reduce or revoke any financial assistance which it has provided, and/ or may require me to refund any such financial assistance, and/or refuse to allow me to register for any course or graduate until such assistance has been repaid in full. I consent to the University undertaking further credit checks or verification of the information provided herein. DATE: SIGNATURE OF APPLICANT: SECTION B: Declaration by PARENT/SPOUSE/LEGAL GUARDIAN (students cannot sign on behalf of parent, spouse or legal guardian) I have checked all the information provided by my son/daughter/spouse in this application for financial assistance and confirm that it is accurate, up-to-date, complete and not in any way misleading. I have also read the declaration signed by my son/daughter/spouse as above, and I understand the consequences that may ensue if any of the information given in this application is inaccurate, incomplete, not up-to-date or misleading. In the interests of good governance and accountability for public funds, I agree that the University may request my individual profile from a credit bureau to verify my employment and income details. I CONSENT TO MY SON/DAUGHTER/SPOUSE/DEPENDENT SIGNING A LOAN AGREEMENT WITH THE NATIONAL STUDENT FINANCIAL AID SCHEME (NSFAS) ON ITS STANDARD TERMS AND CONDITIONS. DATE: SIGNATURE OF PARENT/SPOUSE/LEGAL GUARDIAN: PRINT NAME OF PARENT/GUARDIAN: GENERAL INFORMATION This form is to be returned to the Walter Sisulu University, Student Financial Aid Office by the 30 September The contact details of all the campus Financial Aid Office heads are provided below: Buffalo City Campus Butterworth Campus Mthatha Campus Queenstown Campus Ms Carol Joshua Private Bag X1421, East London, Ms Siya Sifumba Private Bag X3182, Butterworth, Mr Zazi Ntlati Private Bag X1, Mthatha, Ms Pumela Ngele Private Bag X1421, East London, 5200 All complaints can be directed to either the Campus Director on each campus or to the Office of the Chief Financial Officer. PLEASE TICK THE CHECKLIST TO MAKE SURE THAT YOU HAVE ATTACHED ALL THE NECESSARY DOCUMENTS: Student Office use only Certified copy of green bar-coded Identity Document (ID) of applicant Certified copies of birth certificates (preferably unabridged) or IDs of all members of the family and/or death certificates for deceased parents (first-time entering students ONLY) AND Salary/wages slips of both parents and/or other income of any other family member AND/OR Other proof of income (from informal trading, grants etc) If parents/guardian/spouse are/is unemployed, formal confirmation of this from an independent source is required 4

8 WALTER SISULU UNIVERSITY IMPORTANT NOTICE: This is only an application and does not guarantee that you will receive a NSFAS loan or any bursary offered by the University. If you received NSFAS funding before, it does not guarantee that you will receive it again in Read these notes carefully before completing the application form. Make sure that you read every section and that the information you provide is accurate. Please familiarise yourself with the NSFAS rules, terms and conditions published annually and available from the WSU Student Financial Aid Services Offices, or at NB: If students have not been advised of the success of their application for financial aid before registration, they are required to pay the minimum initial payment (as determined by the university) at registration. 1. Incomplete application forms (including those with missing documents) will NOT be accepted. 2. Only original application forms will be accepted and should be submitted at any one of the four campus Student Financial Aid Services Offices. 3. Do not send original documents (birth certificates, IDs, salary advices), with the exception of affidavits. Attach recently certified (within the last 3 months) copies to the application form. Only original affidavits will be accepted. 4. No ed or faxed documents will be accepted. 5. The closing date for all continuing students is the 30 September For students enrolling at WSU for the first time, the closing date for applications will be the 30 November No late or incomplete applications will be accepted, and these students will be responsible for their own student fees in Students who are granted a bursary from another organisation/institution are obliged to inform the campus Student Financial Aid Services Office. WSU reserves the right to withdraw any awards made to the student if the student receives a full bursary from another source. 8. An award is granted for one year only. 9. Non-South African citizens will not be considered. 10. A student must have passed at least 60% of the registered subjects in the previous year to qualify for a NSFAS loan. 11. A student may not receive a loan for longer than five years for a three year degree/diploma or six years for a four year degree. No funding will be awarded to students undertaking a BTech Degree. 12. Any credit balances on student fee accounts will be sent to NSFAS as a first loan repayment. 13. If an application is approved, and the student does not sign a contract after registration, the University reserves the right to withdraw the loan or bursary and the student will be responsible for his/her student fee account. 14. Please make sure you receive a dated acknowledgement of receipt when you hand in this form at the campus Student Financial Aid Office. 5

9 WALTER SISULU UNIVERSITY DOCUMENTS REQUIRED WHEN YOU APPLY FOR A NSFAS LOAN: Kindly send the following documents along with your application form: 1. If both parents are working, recent payslips not older than 2 months are required from each parent. If a parent is paid on a weekly basis, four consecutive payslips should be submitted. If a parent is paid on a two-weekly basis (fortnightly), then two consecutive payslips should be submitted. 2. If the parent/s is/are unemployed, a formal letter from the Department of Labour confirming unemployment status is preferred. This must be supported by an affidavit from the unemployed parent/s, stating how the family is being supported financially in the absence of salary or wages, and a 3 months bank statement. 3. If the parent/s is/are working in the informal sector where official payslips are not issued (e.g. street vending, or informal selling), the rand value of the income gained per month earned in this way must be stated in the affidavit and a three month bank statement should be submitted. 4. If the parent is employed as a domestic worker/gardener, then a letter from his/her employer is required stating the period of employment and the monthly salary. 5. If there is anyone in the family who is receiving a state pension or a child support grant, proof is needed. A certified copy of the most recent pension slip, pay point slip or an original three (3) month bank statement should be submitted. 6. If you are submitting an affidavit, please ensure that it includes your student number, your ID number, the ID numbers of your parents, and clearly states the value of any income received. Affidavits CANNOT be made by the student on behalf of their parents. Affidavits MUST be done by the parents / guardian. 7. If one/both parents is/are deceased, a copy of the death certificate should be submitted. 8. If the whereabouts of one/both parents is not known or if the parent has absconded or does not contribute towards the finances of the family, an affidavit is required from the parent/guardian that the students lives with. The parent writing the affidavit should not only indicate that he/she is single, but also that the other parent s whereabouts are not known and that no financial support is being received. 9. If a student lives with his/her grandparents or another guardian, an affidavit from the grandparents or guardian is required. This affidavit needs to detail the whereabouts of the parents, any rand value amount of support given by the parent (even if there is none), and proof of income for the grandparents/ guardian must be provided. 10. If a sibling (brother or sister to the applicant) over the age of 18 is still living with the family and unemployed, an affidavit from the sibling confirming his/her unemployment is required. If employed, salary advices or wages must be submitted and this is included in the gross income calculation for the family. 11. If a sibling is studying at a tertiary institution (other than WSU), proof of registration of that student is required. If the sibling is studying at WSU currently, his/her student number must be completed in Section 6 on the application form (under current activities). 12. Certified copies of identity documents (or birth certificates, preferably unabridged birth certificates) for every member of the household including the applicant should be submitted by first time applicants only. 13. If the student s surname differs from that of his/her parents, an affidavit from one of the parents must be submitted stating why the surnames differ. 14. All copies of documents MUST be certified on the front face of the document. 6