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PROXA Bursary Application Form

The document is a bursary application form for full-time students, outlining instructions and criteria for submission. Applicants must provide personal details, educational background, intended study plans, and parental information, along with required documents. Incomplete or incorrect applications will be disqualified, and the bursary cannot be used for existing debts.

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lramothwala8
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33 views6 pages

PROXA Bursary Application Form

The document is a bursary application form for full-time students, outlining instructions and criteria for submission. Applicants must provide personal details, educational background, intended study plans, and parental information, along with required documents. Incomplete or incorrect applications will be disqualified, and the bursary cannot be used for existing debts.

Uploaded by

lramothwala8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Bursary Application Form

For Full Time Bursaries


INSTRUCTIONS

1. Read carefully before completing, signing or submitting this form.


2. Ensure that this form is completed in full.
3. Complete in BLOCK LETTERS.
4. Note that this bursary cannot be used to pay for existing loans or debts.

Criteria

5. Ensure that this form is duly signed.


6. Application forms with incomplete information will be disqualified.
7. Application forms with incorrect information will lead to your application being disqualified.

Ensure that you meet the following:

8. Attach ALL of the following documents REQUIRED:

8.1 Certified copy of a valid Senior certificate (if you completed Grade 12).
8.2 Certified copy of the latest academic transcript or record on official letterhead or logo (if
you are already at university).
8.3 Certified copy of a valid South African identity document.
8.4 Applications received after the closing date will not be considered.
SECTION A- PERSONAL DETAILS OF APPLICANT

1. Surname
2. First name
3. Date of birth

4. Place of birth
5. Identity No.
6. SA Citizenship Yes No

7. Gender Male Female


8. Race African Indian Coloured White
9. Do you have a Yes No
disability If YES, describe the nature of disability:

10. Residential
address with
postal code

11. Postal address


with postal code

12. Contact Home Cellular


telephone
number Parent/ Other
Guardian contacts
including dialling
codes
13. Email address

14. Have you ever Yes No


been found If YES, please specify the nature and date of offence:
guilty of a
criminal offence
15. Gross household
income:

SECTION B- HIGH SCHOOL ATTENDED


1. Name of School

2. School address

3. Province

4. Grade (please Currently in grade 12 Completed Grade 12


tick)
5. Years attended From: To:

6. Subjects( List Higher Symbol Standard Symbol Percentage


them below) Grade Grade
6.1

6.2

6.3

6.4

6.5

6.6

6.7

6.8

6.9

NB: Attach proof of the latest results.

SECTION C – POST MATRIC QUALIFICATIONS

1. Full name of highest qualification

2. Nature of qualification Degree


3. Status Presently studying Discontinued
4. If discontinued, for what reason?

5. If presently studying, which year of First Second Third Fourth Year


study? (Please tick) Year Year Year
6. Student number
7. Name of institution

8. Address of institution

9. Subjects Marks/%
obtained
List the subjects 9.1
9.2
9.3
9.4
9.5
9.6
9.7

NB: Attach proof of latest academic results or academic transcript/s

SECTION D – INTENDED STUDY FOR THE NEW ACADEMIC YEAR (Please mark with “X”)

1. Name of qualification

2. Field of study

3. Are you receiving any other bursary Yes No If YES, describe below the nature of financial assistance and
any obligations involved and provide the name of the
or loan institution that granted the bursary/loan assistance

SECTION E – DETAILS ABOUT PARENT(S)/ GUARDIAN (S) /NEXT OF KIN

1. Surname
2. First name
3. Identity No.
4. Relationship Mother Father Other, specify:
5. Residential
address with
postal code

6. Postal address
with postal code

7. Contact Home Cellular


telephone
number Work Other
contacts
including dialling
codes
8. Email address

SECTION F – DECLARATION

1. I hereby, declare that ALL the information provided in this application form is complete and
correct.
2. I hereby, acknowledge that if ANY of the information provided in this application form is
found to be incomplete and /or incorrect, my application will be disqualified.

3. Signature of
3.1 APPLICANT :

3.2 Date :

4. Signature of
4.1 PARENT/LEGAL GUARDIAN:

4.2 Date:

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