ANNEXURE G5
|
DEPARTMENT OF CORRECTIONAL SERVICESEXTERNAL BURSARY APPLICATION FORM2022 ACADEMIC YEAR
This form will be considered as incomplete and will be eliminated if the following documents are not attached to this application:
· Certified copy of ID · Certified copy of matric · Course fee outline/quotation · Acceptance Letter
|
A. PERSONAL DETAILS:
1. Identity number: …………………………………….. 2. Date of birth: ………………………….
3. Title: ………………………………………………… 4. Gender: M F
5. Surname ……………………………………………. 6. Race: Black White Coloured Indian
……………………………………………………………………………………………………………
……………………………………………………………….. Postal Code ……………………………
……………………………………………………………………………………………………………
……………………………………………………………….. Postal Code ……………….
Cell phone no: …………………………….. : E-mail address:…………………………………………
Name: ………………………………………………………………………… Relation: …………………………..
Contact telephone numbers (H): …………………………………………………………………………… (Cell) ………………………………………………………………………….
Residential Address………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………
|
|
B. COURSE DETAILS
2.1 Do you comply with the admission requirements: YES / NO ( If full-time studies please attach acceptance letter or proof of application for acceptance for both accommodation and tuition)
(attach results of previous years)
Part-time Full-time
……………………………………………… …………………..……………………………………….
……………………………………………… …………………..……………………………………….
7. What is your highest qualification at present?…………………………………………………………………………………………………………
8. Are / were you a recipient of a bursary YES / NO If yes, please complete:
a) Study field……………………………………………………………………………………………. b) Bursary granted by: ………………………………………………………………………………….. c) Bursary period: ………………………………………………………………………………………. d) Nature of obligations: ………………………………………………………………………………… e) Have you fulfilled the obligations: …………………………………………………………………….
Qualification/course of study to your personal development plan?
……………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………….
|
|
C. DECLARATION BY APPLICANT
I ……………………………………………………………………ID NO:……………………………………..
HEREBY DECLARE THAT THE INFORMATION GIVEN BY ME ABOVE IS TRUE AND BINDING TO MY CONSCIENCE.
…………………………………………. ……………………………. ………………….. … Name in Bold Signature Date |
|
D. REFERENCES:
Reference 1:
Full name: ………………………………………………………… Id Nr: ……………………………………………….
Relationship: ………………………………………………………….
Contact Details:
Work: ……………………………….. Home: ………………………….. Cell: ………………
E-mail: ………………………………………………………………………
Reference 2:
Full name: ………………………………………………………… Id Nr: ……………………………………………….
Relationship: …………………………………………………….
Contact Details:
Work: ……………………………….. Home: ………………………….. Cell: ………………
E-mail: ………………………………………………………………………A |