PART 1: PERSONAL DETAILS Full Name And Surname: ________________________________________ Address: ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ Valid Contact Number: (________) ________________________ Cellular Number: _________________________________________ Identification Number: Gender:
Male
Race: African
Female Indian
Coloured
White
Nationality: _________________________________ Have You Been Convicted Of A Criminal Offence: ____________ Are/Were You In Receipt Of Another Bursary/Loan: _________ If “Yes” Furnish In Particulars In Respect Of (a) Name Of Authority: __________________________________ (b) Nature Of Obligations: _______________________________ (c) Fulfillment Of Obligations: _________________________ PART 2: EDUCATIONAL QUALIFICATION Name of School Attended: _____________________________________ Year of Completion:
________________
(Fill In Only If Applicable) Degree/Diploma Already Obtained: _________________________ Year Completed: ____________________ Degree/Diploma Currently Studying Towards: _____________________________________________________________________ Current Year/Level: ____________
PART 3 : BURSARY APPLICATION PARTICULARS Type Of Qualification: Degree Diploma
Btech
Field Of Study: ___________________________________________ (N.B Applications Only Accepted For Mechanical & Civil Engineering And Transportation Management) Name Of Institute You Intend Studying At : ___________________ Estimated Cost Of Tuition & Registration : __________________ Have You Been Accepted At The Institute For The Qualification: _______________ (N B It Is Not The Departments Responsibility To Secure Place For You At The Institute) PART 4 : SUPPORTING DOCUMENTS The following documents are required in order for you application to be valid. Mark with an x if documents are attached Certified copy of identification of applicant Certified copy of parent/guardian if applicable Certified copy of matriculation results Acceptance letter from institute Full Name And Address Of Parent/ Guardian (If Applicant Is Under Age) : __________________________ _________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ____________________________________________________________________ We/I realise that this application is for a bursary and not a loan, and declare that the above particulars are complete and correct and that the applicant intends making his/her services available to the Public Service upon obtaining the qualification in question in terms of the bursary contract which is entered into. __________________________ SIGNATURE OF APPLICANT __________________________________ SIGNATURE OF PARENT/GUARDIAN (Only if applicable)
___________ DATE
Post or Hand deliver completed forms to:
___________ DATE
Career Development, Human Resource Directorate, KZN Department of Transport, 172 Burger Street, Pietermaritzburg, 3201
