APPLICATION FOR EXTERNAL BURSARY: FULL …

1 APPLICATION FOR EXTERNAL bursary : full -TIME TERTIARY STUDIES 2015 ACADEMIC YEAR Instructions: 1. Only use BLOCK LETTERS. 2. Only signed applications containing full particulars and all required documents will be considered. 3. Mark appropriate block with x. 4. Submit all APPLICATION forms to Department of Water Affairs, Director: Learning Academy, Private Bag x313, Pretoria, 0001 or email to 5. applications open 1 April 2014 and the closing date is 31 August 2014. applications received after this date will not be considered. 6. Information pertaining to the types of qualifications the Department of Water Affairs support can be found on the web page ( ).

2 7. Applicants that do not receive written communication within 3 months after the closing date should consider their APPLICATION unsuccessful. 1. Personal Information Surname Title Population group African White Coloured Indian Disability Yes No full name (as per green ID book) Identity number Nationality Postal address (for all official correspondence) Residential address Postal Code Postal Code Contact details (Cell) (H) Email address : Contact name and details of parent/guardian or next of kin 2.

3 Proposed qualification for which you require a bursary Name of degree/diploma _____ Major Subjects (1) _____ (2) _____ Name of University / University of Technology _____ 3 3. Other financial support Are / were you in possession of another bursary ? YES NO If "YES", state donor Period of bursary From To Nature of obligation Did you consult a vocational guidance officer YES NO If so, at which institution? 4. Educational qualifications Name of school Highest grade passed Year Subjects Symbol Subjects Symbol Are you studying at present?

4 YES NO If "YES", name of University / University of Technology Date of first registration Student number Degree / Diploma (Complete name of qualification) Major Subjects (1) (2) Normal duration of course year(s) Remaining study period year(s) Indicate your current level of studies S1 or S2 or S3 or S4 / 1st year or 2nd year etc Do you need in service training required by your qualification? If so, when? Do you require compulsory vacation work as per your qualification? If so, when? Attach proof from the university. Do you intend to use on campus accommodation during your study period and have you applied for such accommodation?

5 If not staying on campus, where do you intend to stay? Parents/Family Off campus accommodation (pls explain) Other (pls explain) 5. Documentation Please attach Grade 12 certificate If you are currently studying at a university, please attach a complete official academic record stating year marks / symbols / percentages in respect of all examinations till date Attach copy of ID First time students: Attach copy of proof of APPLICATION /provisional acceptance letter/firm offer from university Attach a copy of your registration letter if you are already accepted/studying at a university 3 6.

6 Declaration I realise that this is a bursary scheme with a service obligation that I am applying for and I undertake to abide by the conditions pertaining to the granting thereof. I declare that above-mentioned particulars are complete and correct. Signature of applicant Date If still a minor, assisted by parent/guardian (signature) Date 7. Particulars of parent/guardian if applicant is a minor Surname Relationship FATHER GUARDIAN MOTHER full names Employer Postal address of parent/guardian Postal Code (Work) (Home) (Cell)