Jan 19, 2017 - PERSONAL PARTICULARS. Title: First name: Surname: Gender: Male. Female. ID/Passport number (if no ID):. A
Scholarship Application Form GROW Leadership Academy February 2017 PERSONAL PARTICULARS Title: First name: Gender: Male Age:
Cell:
Female (
Surname: ID/Passport number (if no ID): Tel:
)
(
)
Email Address: Residential Address: Next-of-Kin’s Full name:
Contact Details:
(
)
GENERAL INFORMATION 1) Work Experience: (if any) *Please fill in from most recent. Tick applicable one: Part time
Full time
From: mm/yyyy Role: Tick applicable one:
Intern
To: mm/yyyy or current Hours per week: Part time
Full time
From: mm/yyyy Role:
Intern
To: mm/yyyy Hours per week:
2) Voluntary Experience: (if any) *Please fill in from most recent. Tick applicable one: Part time
Full time
From: mm/yyyy Role: Tick applicable one:
Intern
To: mm/yyyy or current Hours per week: Part time
Full time
From: mm/yyyy Role:
Intern
To: mm/yyyy Hours per week:
3) In the future what areas of community transformation would you like to be involved in? And why?
4) Where do you see yourself in 5 years’ time?
5) What are your interests and passions?
6) Have you done a course with RLabs or the Youth Cafe? (If ‘Yes’ specify below) Yes
No
Course/s completed:
HIGH SCHOOL DETAILS School name: Highest grade successfully completed:
Year:
TERTIARY EDUCATION Have you studied after Matric? If ‘Yes’ what was it? Yes Did you complete your studies? Yes
No
No
Name of Qualification: Year you have graduated: OTHER INFO Monthly household income (circle the applicable box): None
R 1,000 and below
R 1,000 – R2, 000
R 2,000 – R3, 000
R 3,000 – R 5,000
R 5,000 and above
Number of household members: How did you hear about GROW Leadership Academy? Relative
RLabs
Youth Cafe
School
Friend
Social Media
Other
I agree that all the above information is correct and I have read and understood the Terms and Conditions there in. Applicant Signature:
Date:
Please attach a copy of your ID/ Passport and your School certificate to this application form. Terms and Conditions An 80% attendance is required in order to graduate. Successful candidates will be informed in writing (sms) as of 20 January 2017. The scholarship covers your class fees to the value of R26 000. o Training materials used in class (Purchase using Zlto) * Transport will NOT be provided for any student. Closing date for applications is the 19th of January 2017. Meet & Greet/Taste & See will take place on the 23rd of January 2017.
