Financial Support Services FUNZA LUSHAKA …

1 Financial Support Services FUNZA LUSHAKA bursary INFORMATION AND APPLICATION FORM / RE-APPLICATION FORM PARTICULARS OF STUDENT STUDENT NUMBER Maiden surname, if applicable First names Identity number Date of Birth ATTACH CERTIFIED COPY OF ID d d M M Y Y Y y Gender (tick one block) Male Female Race for statistics only (tick one block) African Coloured Indian White Home Language (tick one block) African Language Afrikaans English Other (please specify) Home Address Postal Code Home telephone number Area Code Number Cell phone Postal Address while studying Postal Code Telephone number while studying Area Code Number Cell phone E-mail address PARTICULARS OF NEXT OF KIN Surname Initials Title Relation (mother, father, brother, sister etc.)

2 Next-of-kin Residential Address Postal Code Next-of-kin telephone number Area Code Number Cell phone PARTICULARS OF HIGHER EDUCATION INSTITUTION AND STUDY PROGRAMME On which campus are you registered? (tick one block) Potch Campus Vaal Triangle Campus Mafikeng Campus Degree (tick one block) PGCE Phase specialization (tick one block) Foundation Phase Intermediate Phase Senior Phase FET Intermediate & Senior Senior & FET If Foundation Phase, are you able to teach in an African language (tick one block) YES NO If YES, in which African language? Year of study in 2013 (tick one block) 1st 2nd 3rd 4th PGCE year TEACHING SPECIALISATIONS Please indicate which priority areas you will be specializing to teach.

3 Tick a maximum of 2 learning areas and/or subjects Foundation Phase (Grade R-3) Intermediate Phase (Grade 4 6) Senior Phase (Grade 7 9) FET Phase (Grade 10 12) Foundation Phase Specialisation African Languages African Languages African Languages African Languages English Language English Language English Language Mathematics Mathematics M athematics Natural Sciences Natural Sciences M athematical Literacy Technology Technology Agricultural Sciences Agricultural Technology Civil Technology Computer applications Technology Electrical Technology Engineering Graphics and Design Information Technology Life Sciences Mechanical Technology Physical Sciences Accounting Economics Geography FUNZA LUSHAKA bursary RECEIVED IN PREVIOUS YEARS

4 Did you receive a FUNZA LUSHAKA bursary in previous years? (tick one block) YES NO Did you receive a FUNZA LUSHAKA bursary last year? (tick one block) YES NO DECLARATION BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE FUNZA LUSHAKA bursary CONDITIONS. I HAVE READ AND UNDERSTOOD THE CONTENT OF THIS APPLICATION. THE INFORMATION SUPPLIED IS TRUE AND CORRECT. SIGNED by the STUDENT at .. on this .. day of .. (STUDENT SIGNATURE) VERY IMPORTANT NOTES THAT APPLY TO THE COMPLETION OF THE APPLICATION FORM THIS DOCUMENT IS THE APPLICATION FORM. IN ADDITION TO COMPLETING AND SUBMITTING THIS APPLICATION FORM, ALL APPLICANTS MUST REGISTER ON THE FUNZA LUSHAKA WEBSITE.

5 REGISTRATION ON THE FUNZA LUSHAKA WEBSITE WILL COMMENCE FROM THE END 2012. FAILURE TO REGISTER MAY RESULT IN DISQUALIFICATION OF THE APPLICATION. FUNZA LUSHAKA IS ASSEMBLING A NATIONAL DATABASE OF ALL APPLICANTS AND THEREFOR NEEDS EVERY STUDENT S DETAILED INFORMATION. (WEB ADDRESS AT BOTTOM OF PAGE) IN ADDITION, EVERY SUCCESSFUL APPLICANT WILL HAVE TO COMPLETE AND SUBMIT A LEGAL BINDING CONTRACT BEFORE THE bursary WILL BE ALLOCATED TO THE STUDENT ACCOUNT. SUCCESSFUL APPLICANTS WILL BE NOTIFIED BY THEIR Financial AID OFFICE DURING 2013 OF HOW AND WHERE THE CONTRACT MUST BE OBTAINED.

6 1. The bursary is only awarded to South African citizens and this application will not be considered unless a certified copy of the applicant s ID document as well as a printout of the online application is attached to this application form. 2. The Department of Education prefers to use e-mail or SMS as means to communicate with bursars and should you be awarded or re-awarded the bursary , you will be expected to have an e-mail address and if possible a cell phone contact for SMS purposes. 3. The bursary will only be awarded if the student s academic performance is in compliance with FUNZA LUSHAKA s predetermined requirem ents and one of the priority area specialization subjects is included as a teaching subject in your qualification.

7 4. Once inform ed that you qualified, you will be required to take up a provincial teaching position and you will not be granted permission to defer this contractual obligation to continue with full-time studies. Nor will you be granted permission to take a gap year . 5. One of the contractual obligations of this bursary is that you are required to teach in a provincial teaching post and you are free to choose the province in which you would prefer to teach. However, should the province of your choice not be able to offer you a post, then you will be offered a post in any of the other provinces and to meet your contractual obligations, you will have to accept the offer.

8 6. The bursary must be repaid if the recipient fails to qualify, fails to apply for a teaching post with a provincial education department at a school, fails to take up a teaching post with a provincial education departm ent at a public school, leaves a teaching post with a provincial education department before the end of the contracted service period, or otherwise fails to meet a requirement of the bursary agreement. 7. The amount that is repayable is the full amount of the bursary received under the programme, less one year s funding for every year spent teaching at a public school.

9 Interest will be charged at the rate determined by NSFAS from time to tim e, which is always less than the commercial rate. 8. The bursary is awarded for one academic year at a time. Upon receipt of academic results conforming to FUNZA LUSHAKA s predetermined requirements, the bursary may be renewed each year until the recipient of the bursary has qualified as a teacher. Recipients of bursaries will be required to teach one year for every year the student received the FUNZA LUSHAKA bursary . TEACHING PREFERENCE If you should qualify, in which province would you prefer to teach after graduation? (Tick one block) Eastern Cape Northern Cape Western Cape M pumalanga Gauteng North-West Free State Limpopo KwaZulu-Natal CLOSING DATE FOR applications Prospective Students : 30 November (preceding year) Senior Students : 15 October (preceding year) CONTACT PERSON FOR ENQUIRIES ON YOUR CAMPUS MAFIKENG : Thabang M atabane Tel: (018) 389-2300 E-M ail: Private Bag X2046, MMABATHO, 2735 Great Hall, Room 101 POTCHEFSTROOM : Triens Jacobs Tel: (018) 299-2047 E-M ail: Private Bag X6001 POTCHEFSTROOM , 2520 Building F19 VAAL TRIANGLE : Tumi Mokoena Tel: (016) 910-3134 E-Mail.

10 PO Box 1174 VANDERBIJLPARK, 1900 Building 24, Room G52 FUNZA LUSHAKA WEB ADDRESS: FSBRV/FSS BURSARIES/ FUNZA /POTCH