Potatoes SA Bursary Application Form Undergraduate Studies

BURSARY APPLICATION FORM
-UNDERGRADUATES STUDIES-
 Closing Date for bursary application: 31 October of each year

 Give concise answers and where applicable, mark with an X.
 Incomplete or late applications will not be considered.
 Only SA Citizens will be considered.
 Please forward your applications to our Bursary Department via Email as follows:
Email: [email protected]
SECTION A- PERSONAL DETAILS:
Title………………… Surname…………………………………………………………………….
First Names:…………………………………………………………………………………..........
Identity number:…………………………………………………………………………………….
Race: (Please mark with an X)
African Coloured Indian White
Date of birth:………………………………………… Age: ………………………………………..
Male or Female:……………………………………. Home Language:……………………………..
Citizenship:……………………………………………………………………………………………
Marital Status:………………………………………Dependants:………………………….
Physical Street Address: …………………………………………………………………………....
Suburb:………………………………………………………………….............................................
City: …………………………………………………………………………………………………....
Postal Code:……………………………………………………………………………………………
Telephone No:………………………………………Work……………………………………………
Cell:……………………………………………………………………………………………………..
Email Address:………………………………………………………………………………………....
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Preferred Method of Correspondence: (Please mark an X next to your choice)
Email:………………..Post:……………………… Telephone: ………………………………….
Emergency Contact Person:……………………………….Relationship:………………………..
Contact Number:……………………………………………………………………………………..
Where did you hear about Potatoes South Africa’s Bursaries? (Please mark an X next to
your choice)
University Potatoes SA Career Fair Friend Other

Staff/ College Website
Staff
If other, please specify:……………………………………………………………………………..
SECTION B- DETAILS OF THE UNIVERSITY/ COLLEGE :
Name of the Institution you are studying at:…………………………………………………………
Physical Address of the institution:…………………………………………………………………
……………………………………………………………………………………………………………
Province:………………………………………………….. Code: …………………………………..
Institution contact Number:…………………………………………………………………………..
Course of Study:……………………………………………………………………………………….
Student Number (if applicable):………………………………………………………………………
Main Subjects:………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………
Please mark the academic year for which you are applying (Please mark with an X)
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1. What Agricultural Career do you intend on following on completion of your studies:
………………………………………………………………………………………………………
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2. Please tell us why your bursary application should be considered in terms of your
academic ability and future career plans.
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SECTION C: OTHER BURSARIES OR SPONSORS:
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Are you at present studying with a bursary? Yes No
If yes, name the bursary:…………………………………………………………………………...
Do you have or have you received a study Yes No

loan?
If yes, name of the loan:……………………………………………………………………………
For what purpose: …………………………………………………………………………………..
SECTION D: DOCUMENTATION
Please attach copies of the following:
 Certified copy of your ID

 Certificates of Qualifications
 Most Recent Academic Transcripts
 Institution Admission Letter
 Any other supporting documents that are relevant to your application
 Please forward your application to our Bursary Department via email as follows:
Email: [email protected]
SECTION E: DECLARATION BY STUDENT
I declare that I have read the conditions that apply to this award. I acknowledge that I
understand and accept these conditions in full, and I agree to abide by them. Furthermore,
I hereby confirm that the above information is true and correct.
NB: Due to the large number of applications we always receive, applicants should
deem their applications unsuccessful if they are not contacted by the end of February
of the next year.
APPLICANT’S SIGNATURE:……………………………………………… DATE: …………………………………….

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BURSARY APPLICATION FORM

 Closing Date for bursary application: 31 October of each year

SECTION A- PERSONAL DETAILS:

Race: (Please mark with an X)

African Coloured Indian White

Date of birth:………………………………………… Age: ………………………………………..

Male or Female:……………………………………. Home Language:……………………………..

Physical Street Address: …………………………………………………………………………....

Email:………………..Post:……………………… Telephone: ………………………………….

Emergency Contact Person:……………………………….Relationship:………………………..

University Potatoes SA Career Fair Friend Other

If other, please specify:……………………………………………………………………………..

SECTION B- DETAILS OF THE UNIVERSITY/ COLLEGE :

Name of the Institution you are studying at:…………………………………………………………

Physical Address of the institution:…………………………………………………………………

Province:………………………………………………….. Code: …………………………………..

Institution contact Number:…………………………………………………………………………..

Student Number (if applicable):………………………………………………………………………

1. What Agricultural Career do you intend on following on completion of your studies:

SECTION C: OTHER BURSARIES OR SPONSORS:

Do you have or have you received a study Yes No

If yes, name of the loan:……………………………………………………………………………

For what purpose: …………………………………………………………………………………..

Please attach copies of the following:

 Certified copy of your ID

SECTION E: DECLARATION BY STUDENT

APPLICANT’S SIGNATURE:……………………………………………… DATE: …………………………………….

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