Feb 17, 2017 - Socio Economic Status Unemployed. Employed. Telephone Number. Fax Number: Cell Phone Number. Email Addres
W&RSETA BURSARY APPLICATION FORM - 2017 NB: Please Complete All Sections of the Application Form in Full. Applications Received after the closing date (17 February 2017) will not be considered Applications must be accompanied by supporting documents (refer to section I of the Application form) Applications must be emailed to:
[email protected] Were you previously awarded a bursary by W&RSETA
Yes
No
Have you been accepted at the TVET College or Institution for 2017 academic year
Yes
No
Have You Matriculated
Yes
No
Name of High School
Yes
No
Year Obtained
Yes
No A.
PERSONAL DETAILS
ID Number Title
Mr
Mrs
Ms
First Name
Initials
Surname Date of birth
Gender
Male
Female
Equity
Black
Coloured
Indian
White
Home Language Nationality Citizen Residential Status Socio Economic Status
South African
Permanent Resident
Unemployed
Dual Resident (SA +other)
Employed
Telephone Number
Fax Number:
Cell Phone Number Email Address POSTAL ADDRESS
PHYSICAL ADDRESS
Postal Address
Physical Address
Postal Code
Postal Code
District
District
Municipality
Municipality
Province
Province
Is your Area Rural or Urban:
W&RSETA BURSARY APPLICATION FORM 2017
Rural
Urban
Page 1 of 5
B. PARENT OR GUARDIAN DETAILS ID Number Title: Mr
Mrs
Ms
Dr
Prof
Adv
First Name
Initials:
Surname Cell Number
Date of Birth
Email Address Gender
Male
Female
Equity
Black
Coloured
Home Language
Indian
White
Relationship to Applicant
Nationality Marital Status
Single
Married
Socio Economic Status
Widowed
Employed
Divorced Unemployed
C. PARENT OR GUARDIAN EMPLOYER DETAILS Name of Employer Employer address Physical Code
Postal Code D. PARENT OR GUARDIAN INCOME DETAILS
Source of Income: Salary
Wages
Self Employed
Pension
Social Grant
Social Grant Number
Number of Dependents
Gross Household Income (per month)
Disposable Income (per month) E. STUDY DETAILS
Bursary Application for :
TVET College
University of Technology
University
Yes
Have you been accepted:
No
F. STUDY DETAILS FOR TVET COLLEGES (Complete this section if you are accepted or registered at a TVET College) Name of TVET College : Name of TVET College Campus Region (Where the TVET College is located e.g. Centurion) Province (Where TVET College is located e.g. Gauteng) Student Number: Study Course (e.g. N6 Financial Management) Field of Study or Discipline (e.g. Financial Management) Year of Study in 2017
N4
N5
N6
NCV level 2
NCV level 3
NCV level 4
Expected Year of Completing the Studies (e.g. 2018) Duration of the Qualification Qualification Type
3 Semesters
Nated N6
W&RSETA BURSARY APPLICATION FORM 2017
4 Semesters NCV level 2
3 Years NCV level 3
NCV level 4
Page 2 of 5
G. STUDY DETAILS FOR UNIVERSITY OF TECHNOLOGY OR UNIVERSITIES (HET) (Complete this section if you are accepted or registered at a HET) Name of Institution Name of Campus Region (Where the University is located e.g. Pretoria West) Province (Where the University is located e.g. Gauteng) Student Number Study Course Field of Study or Discipline 1st Year
Year of Study in 2017
2nd Year
3rd Year
Expected Year of Completing the Studies (e.g. 2019) Duration of the Qualification
3 Years
4 Years
Qualification Type
Degree
Diploma
H. ACCOMMODATION Accommodation Status
Residing at TVET College / University Accommodation
Residing at Home
Are you staying or will you be staying at TVET College/ University residence or Accredited/ Leased/ Contracted student accommodation:
Yes
No
If you ticked yes above, Name of Accommodation I. FEE COST BREAK DOWN Registration Fee Tuition Fee (include First and Second Semester fees) Accommodation if applicable: Book Allowance Meal Allowance (Cannot exceed R16 000 per annum) TOTAL J. CHECKLIST FOR SUBMISSION OF SUPPORTING DOCUMENTS REQUIRED (Your application must be accompanied by the following documentation listed below. Application Forms with incomplete supporting documents will not be considered)
Certified Copy of South African ID Statement of Results /academic record Proof of admission or proof of registration Statement of fees Proof of accommodation if staying in residence and not reflected on the statement of fees Proof of Parent or Guardian’s Income
W&RSETA BURSARY APPLICATION FORM 2017
Page 3 of 5
DECLARATION OF AUTHENTICITY
I declare that the information supplied in this application is to the best of my knowledge true and correct. I understand that any false information will automatically disqualify me from obtaining any funding and could further lead to me being charged in a Court of Law for fraudulently receiving funding. Signed at
on this
day of
2017
Signature
W&RSETA BURSARY APPLICATION FORM 2017
Page 4 of 5
FOR OFFICE USE ONLY
APPLICATION NO.
DATE RECEIVED
APPLICATION REVIEW DATE
OUTCOME OF APPLICATION : Accepted
Declined
PLEASE RETURN THE APPLICATION FORM VIA EMAIL:
[email protected] OR DELIVER AT YOUR NEAREST W&RSETA OFFICES
W&RSETA BURSARY APPLICATION FORM 2017
Page 5 of 5
