bursary application form for full time post graduate studies - Ilembe

BURSARY APPLICATION FORM FOR FULL TIME POST GRADUATE STUDIES YEAR 2015/16     

Closing date for bursary application: ……………15 August 2015……………… Use block letters to complete the form. Give concise answers and, where applicable, mark with an X. Attach a recent copy of your ID, academic records and copies of qualification/certificates. Incomplete or late applications will not be considered.

How did you learn about the Transport Education Training Authority bursary? Newspaper

University / School/Tertiary Institution

Friend/ Family

SECTION A:

TETA Website

Internet/Social Media

Career Expo/ Awareness

Email

Other (Specify)

PARTICULARS OF APPLICANT

Gender Title

Ms

Dr

Hon

Mr

Mrs

First Name(s) of Leaner (as reflected on ID) Surname of Learner Date Of Birth

Y

Y

Y

Y

M

M

D

D

Learner ID number Learner Mobile/ Cell phone Number Learner Alternative Contact Number Learner Email Address

Surname: Identity Number

DETAILS FOR PARENTS /GUARDIAN/NEXT OF KIN Title: Initials:

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(

Telephone Number

Mobile No

)

Other (Specify) Relationship

Mother

Fax Number Email Address

(

Home Physical/ Residential Address (Not Your University / College or P.O.Box)

Father

)

Municipality C o d e

Province

Postal Address While Studying Which Is Not Your University/College Address (if not the same as above)

Municipality Province

SECTION B DISABILITIES/SPECIAL NEEDS This information will not disadvantage your application Yes If Yes please specify:

Code

No

Sight – conditions corrected with spectacles are not applicable Hearing (even with hearing aid)

Communication (talking, listening) Do you have any disabilities/ special needs

Physical (moving, standing)

If other please specify …………………………………………………………………………. ……………………………………………………………………………………………………… …….

Population Group/Race (for statistical

……………………………………………………………………………………………………… ……. African Coloured Indian White Page 2 of 8

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purposes)

M

F

M

F

M

F

M

F

C. PARTICULARS OF POSTGRADUATE FOR WHICH YOU WISH TO RECEIVE A BURSARY

HONOURS STUDY

MASTER’S STUDY

DOCTORAL STUDY

At which university/institution are you/do you intend studying? ................................................................... 1

2

3

4

Mark the academic year/s for which you are applying? Short description or title of proposed research project.

Details of the research proposal. Indicate the problem statement and the importance of your study (research) to society and the transport sector.

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D. EDUCATIONAL QUALIFICATIONS List all the degrees/diplomas obtained, including the present degree: Degree/Diploma

First Registration (year)

Year Obtained

Full time/ Part Time

Name Of Institution

NB: Full certified copies of academic records must be attached for each degree/diploma obtained.

If you are not currently enrolled at an educational institution, please indicate what you are doing at present.

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E – FINANCIAL DISCLOSURE - OTHER BURSARIES/STUDY LOANS: (All funding applied for or received/guaranteed)

Are you at present studying with a bursary? YES

NO

If yes, name of the bursary.............................................................................................................................................

STUDIES FUNDED BY:

APPLICATION (X) or GUARANTEED (√)

AMOUNT

1 2 3

Father’s occupation........................................................................................................................................................ Mother’s occupation...................................................................................................................................................... Guardian’s occupation...................................................................................................................................................

Mark your father’s net monthly income group (R) < 2 500

2 501–5 000

> 5 000 Attach A Proof Of Income (Most Recent Payslip, Pension Slip, Bank Statement)

Mark your mother’s net monthly income (R) < 2 500 2 501–5 000 > 5 000

Or Mark your guardian’s net monthly income (R) < 2 500 2 501–5 000 > 5 000

A Sworn Affidavit

No of family members staying in the household …………………………………………………………………………………………………. How many other dependants are still in the household? ....................................................................................... No. of dependants at tertiary institution staying in the household.......................................................................... Do you have or have you received a study loan? YES

NO

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If yes, name of the loan.......................................................................................................................................................... For what purpose? ................................................................................................................................................................ When did you get it? .............................................................................................................................................................

F. RESEARCH EXPERIENCE AND OUTPUT List all scientific articles/papers you have published and/or presented and the name of the journal or conference where the article was published or presented. Article title ………………………………………………………………………………………………………………………………………………………………… Authors……………………………………………………………………………………………………………………………………………………………………….. Journal name/Conference name……………………………………………. Date published/presented…………………………………………… Article title..................................................................................................................................................................... Authors ………………………………………………………………………………………………………………………………………………………………………. Journal name/Conference name ………………………………………………………. Date published/presented.................................

G. DOCUMENTATION Please attach certified copies of the following:  Identity document  Certificates of qualifications  Academic records  Family income or an affidavit if parents are unemployed  Admission letter H. DECLARATION I declare that I have read and understood the contents of this Application Form as well as certify that the information supplied in this application is true and correct. If I am awarded a bursary I will abide by the requirements applicable.

Signature of applicant ........................................................................... Date.................................................................

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FOR BURSARY OFFICE USE ONLY Date received: _______/______________/ 2015

Received by:_____________________

Signature of Recipient …………………………………………………………………….

STAMP

CHECKLIST FOR APPLICANTS (N.B. PLEASE SUBMIT ALL RELEVANT DOCUMENTS WITH YOUR APPLICATION)

YES

NO

All required sections of the application form filled in appropriately.(Section A – Personal Particulars Of Applicant, Section B –Disabilities/ Special Needs, Section C- Particulars of Degree/ Diploma For Which You Wish To Receive The Bursary, Section D Financial Disclosure- Other Bursaries/ Sponsors, Section E- Family Household Income, Section F -Project Plan, Section G- Project summary, Course Cost, Accommodation quotation, Transport), Section H – Declaration, Section I – Learner Assessment Checklist -

Institution FET/HET/ Regulatory accreditation document by the relevant institution. (NB: does not apply to Public HET institution)

-

Application form signed and dated by the learner and parent or guardian where applicable. Proof of registration / FET/HET/Other institution Enrolment form from institution/ FET/HET/Other institution

-

Acceptance letter form an institution/ FET/HET/Other institution

-

Learner certified ID copy. Affidavit / proof of non- affordability by parent/guardian Certified ID copy of parent/guardian Quotation / (pro-forma) of full course from institution/ FET/HET/Other Institution Quotation for accommodation at a university residence / accommodation accredited by the university /institution

- A certified copy of your previous qualification ( Diploma or Degree) Have I completed the application form adequately and requested assistance from TETA where in need of Page 7 of 8


further clarity?

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