Application for Admission for the Year 2014 First-time Undergraduate
Form No:
PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THE FORM 1. This is only an application for admission to an academic programme. Complete the accommodation application form (if accommodation is required). 2. To avoid delay in processing, all information required must be filled in as accurately as possible. Office Use 3. Indicate your campus of preference below. 4. Address your application to the Registrar at the postal address as indicated below. ENQ Initials
STN
Surname
Application fees and closing dates: - a non-refundable application fee must accompany the application. USE THE ENQUIRY NUMBER AS YOUR REFERENCE ON YOUR DEPOSIT SLIP Application Fee
Late Application Fee
South Africans applicants
R100.00
R190.00
International and SADC applicants
R180.00
R350.00
Faculty
Closing Date
Closing Date
Health Sciences
31 August 2013
30 September 2013
Science, Engineering and Technology
30 September 2013
31 October 2013
Business, Management Sciences and Law
30 September 2013
31 October 2013
Education
30 September 2013
31 October 2013
Delivery Site
Selection
Address
Method of Payment
Nelson Mandela Drive
Private Bag X1, Mthatha, 5117. Tel: 047 502 2443/8
Bank Deposit: First National Bank Walter Sisulu University, Acc. No.: 62099126601 Branch Code: 210521
Zamukulungisa
Private Bag X6030, Mthatha, 5100. Tel: 047 501 1400
Ibika
Private Bag X3182, Butterworth, 4960. Tel: 047 401 6000
Queenstown
P.O. Box 876, Queenstown, 5320. Tel: 045 807 8702
Chiselhurst
P.O. Box 19712, Tecoma, 5214. Tel: 043 709 4000
Potsdam
Private Bag X1421, East London, 5200. Tel: 043 708 5200
College Street
Bank Deposit: First National Bank Walter Sisulu University, Acc. No.: 52120232526 Branch Code: 210121
Bank Deposit: First National Bank Walter Sisulu University, Acc. No.: 55990711126 Branch code: 210121
Postal orders to be made payable to: Walter Sisulu University Have you ever studied at any of these institutions before? UNITRA
Eastern Cape Technikon
Y
/
N
If YES, provide Student Number:
Border Technikon
Proposed Course of Study
Full Time
Choice 1 Choice 2 OFFICE USE ONLY: Selection/Assessment results Mark with ‘X’ Choice 1
Admitted
Rejected
Provisionally Admitted
HOD: Surname:
Initials:
Signature:
Date:
Choice 2
Admitted
Rejected
Interview / test date:
Provisionally Admitted
HOD: Surname:
Initials:
Signature:
Date:
Interview / test
Interview / test
Interview / test date:
1
Part Time
Preferred Campus
Mthatha
Butterworth
Buffalo City
Queenstown
SECTION A: Personal Details Mr/Mrs/Miss/Dr/Prof
Surname
Initials
First Name(s) Maiden Name (if applicable)
Date of Birth
I.D. Number (SA Identity No. Only)
Gender/Race
Male
Female
Black
White
Marital Status
Single
Married
Divorced
Widowed
Home Language
Coloured
Indian
Other
Religion
Nationality SA Citizen
Y
/
N
If NOT a South African Citizen, please tick one of the options below:
(A) African (African countries) (E) Exchange Student
(F) Foreign (outside Africa)
(R) Refugee Permit
(N) Permanent Resident
Passport No.
Study Permit No.
Study Permit Expiry Date
Occupation
Contact Information (COMPULSORY) Postal Address Postal Code Province (if residing in SA) Telephone No.
Int. Code +
Number
Mobile (Cellular) No. Int. Code +
Number
Email Address Physical Address (Street or Administrative Area - NOT P.O. Box)
SECTION B: Parents Information FATHER
Initials
Surname
I.D. Number (SA Identity No. Only)
Contact Number:
Occupation Postal Address
Physical Address
Email Address
MOTHER
Initials
Surname
I.D. Number (SA Identity No. Only)
Contact Number:
Occupation Postal Address
Physical Address
Email Address
2
GUARDIAN / NEXT OF KIN
Initials
Surname
I.D. Number (SA Identity No. Only)
Contact Number:
Occupation Postal Address
Physical Address
Email Address SECTION C: What are you doing this year? University
Teachers College
Nursing School
FET College
Working
Grade 12
Other
If Other, specify
SECTION D: Physical Limitation (Confidential) In order for Walter Sisulu University (WSU) to provide you with the necessay services, we need you to indicate your disability status at the time of your application. Every reasonable attempt will be made to provide you with the assistance you may need as a result of your disability. Are you Physically Challenged
Y
Blind or Partially Sighted
/
N
If yes, please specify below:
Hearing (even with hearing aid)
Physical (moving, standing, grasping)
Communication (talking, listening)
Intellectual (difficulties in learning)
Emotional (behavourial or psychological)
Multiple/Other (Please specify) SECTION E: Post-School Academic Activities - Qualification/s Obtained Qualification/s Obtained
Institution
Year
SECTION F: Matric / Grade 12 Information Current Grade 12 Learners Examination Centre No.
Exam No.
If you have already completed Matric/Equivalent, please complete this section and attach a certified copy Matriculation/Equivalent Status
Endorsement
Senior Certificate
Foreign Qualification
Other
Other, specify School Name Postal Address
Postal Code SECTION G: Application for Recognition or Exemption of Subject Do you wish to Apply for Exemption of Subjects/Courses? Institution
Y
/
N
If yes complete information below and attach copies of results
Subject Name
Level
3
Year passed
SECTION H: Declaration by Prospective Student 1. 2. 3.
4. 5. 6. 7.
I declare that all particulars given by me on this application form are true and correct. I agree that any misrepresentation due to the information provided on this form or the withholding of information shall cause this application to become null and void at the discretion of the University without prejudice to its rights. If my application is successful, I undertake to: a. Comply with the rules and regulations of the University. b. Inform the Registrar immediately in writing of any change of address. c. Acquaint myself with the rules and general regulations relating to the programme to which I am admitted. I am fully aware that the University is under no obligation to provide me either with financial assistance or accommodation. I acknowledge that all fees have been determined by the Council of the University. I agree that the relevant fees will be paid as indicated in the Prospectus of the University by the due date. If such fees are not paid, I acknowledge the rights of the University to cancel my registration at any time and to demand payment of the amounts owing by me and/or my parent/guardian. Should I, during the course of my studies at the University, sustain any injuries or contract any illness or suffer any loss or damages, I hereby undertake not to institute any claim against the University on account thereof, irrespective of the cause of such damage or loss. In the event of my death during the course of studies, this undertaking shall be binding on the executor of my estate and my heirs and successors-in-title. Under the circumstances referred to above, I or my executor, administrator, heirs and succesors-in-title, hereby indemnify the University in respect of any damages suffered by me arising from any causes referred to above. Date
Signature of Student SECTION I: Declaration by Parent/Guardian
I, (full names) _____________________________________ hereby grant permission for the declaration and undertaking made by the applicant, and I accept joint and several liability as co-principal debtor with the applicant for the payment of all fees due by him/her to the University. Date
Signature of Parent/ Guardian SECTION J:
If you have registered to write the National Benchmark Test or have already written the test, please provide your reference number: ………………………………………………………………………….. DOCUMENTS TO BE SUBMITTED WITH THE APPLICATION FORM
CHECKLIST
Certified copies of:
YES
1. Birth certificate AND ID document. 2. Matriculation endorsement, senior certificate or equivalent qualification. 3. Your transcript of academic record or certificate of conduct in respect of studies completed at any other educational institution, if applicable. 4. Certificates, diplomas or degrees previously obtained. 5. Marriage or divorce decree for different surnames. 6. For conditional or mature age exemption, submit in person all original documents listed in 1, 2, 3, 4 & 5. 7. The original copy of the study permit or proof of permanent residency must be submitted by all foreign applicants. 8. The identity documents of parent/s or legal guardian. 9. International students should attach SAQA results. OFFICE USE ONLY: APPLICATION PROCESSING LOG Action
Date
Staff member name and surname
1. Application form sent to applicant 2. Application form received from applicant 3. Acknowledgment sms/letter sent to applicant 4. Captured onto WSU system 5. Sent to Academic Department for Choice 1 6. Received from Academic Department Choice 1 7. Send Choice 1 admission status results by sms/letter 8. Sent to Academic Department for Choice 2 9. Received from Academic Department Choice 2 10. Send Choice 2 admission status results by sms/letter
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Signature
NO
Application for Residence for the Year 2014 First-time Undergraduate Preferred Campus
Mthatha
Butterworth
Buffalo City
Student Number
Applicant’s Particulars Mr/Mrs/Miss/Dr/Prof
Surname
Initials
First Name(s)
Date of Birth
I.D. Number (SA Identity No. Only)
Date of Application SA Citizen
Y
/
N
If No, Citizenship
Passport No.
Study Permit No.
Study Permit Expiry Date
Course of Study
Postal Address Postal Code Province (if residing in SA) Telephone No.
Int. Code +
Number
Mobile (Cellular) No. Int. Code +
Number
Physical Address (Street or Administrative Area - NOT P.O. Box)
Email Address State of Health General state of Health
Good
Fair
Poor
Particulars of physical disabilities (very important for room allocation)
SECTION H: Declaration by Prospective Student I declare that the information given in this application form is correct and that any incorrect information given here could lead to withdrawal of an offer for accommodation, expulsion from a WSU Residence or disciplinary action. I also declare that I will abide by all rules and regulations of the Walter Sisulu University, should I be admitted to WSU residences. Date
Signature of Student Office Use Only Application processed by: Application
Surname Approved
Initials Not Approved
Hostel Name
Room No. Date
Signature of Residence Officer
Proof of submission of Application Form for 2014
Enquiry No:
Surname: ............................................................................ Initials: .................. ID: ................................................................ Proposed course of study: 1............................................................................................................................................................ Campus/site: ................................................................................................................................................................................. Date of submission: ................................................................... Place: .......................................................................................... 5
WALTER SISULU UNIVERSITY FINANCIAL AID APPLICATION FORM 2014 ACADEMIC YEAR CLOSING DATE (currently registered students): 30 SEPTEMBER 2013 CLOSING DATE (first time entrants to WSU): 30 NOVEMBER 2013 NO LATE APPLICATIONS WILL BE ACCEPTED PLEASE NOTE: •
Only South African students currently registered (continuing students) or students applying for admission (first-year students) can apply for financial aid. • If you provide incorrect or false information on this application form, you will be disqualified and you will forfeit your NSFAS Loan. • Incomplete application forms (including those with missing documents) will NOT be accepted. • Only original application forms will be accepted and should be submitted at any one of the four campus Student Financial Aid Services Offices. Students may apply online (check www.wsu.ac.za for details) but will still need to submit copies of required documents. • No emailed or faxed documents will be accepted. • If your application is approved, and you do not sign a pre-agreement quotation AND a loan agreement form OR bursary agreement form after registration, the University reserves the right to withdraw your loan/bursary funding and you will be responsible for settling your student fee account. • PLEASE READ THE INSTRUCTIONS ON PAGES 5 AND 6. SIGNATURE OF APPLICANT: _______________________________ DATE ______________ Please read the notes and instructions in the financial aid brochure before completing the application form. FOR OFFICE USE ONLY DATE RECEIVED:
NAME AND SIGNATURE OF FAO:
DATE PROCESSED:
NAME AND SIGNATURE OF FAO:
Total Gross Income
EFC value
Within N+2
YES / NO
SECTION 1: STUDENT APPLICANT INFORMATION (CROSS OUT WHERE APPROPRIATE, USE PRINT LETTERS) First Names (as per ID document): Surname:
Gender:
Marital Status: Married / Single / Divorced / Widowed / Separated ID:
Male / Female
Race: African / Indian / Coloured / White / Other Student No:
Home address (where your family lives):
City:
Province:
Postal Code:
Postal Address : Email Address:
Postal Code: Cell No:
Do you have a physical disability, or a visual or hearing impairment? (If so, please ask the FAO for more information on the bursaries for persons with disabilities and the requirements for this bursary).
YES / NO
Would you like to receive a book allowance as part of your loan?
YES / NO
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WALTER SISULU UNIVERSITY Would you like to receive a meal allowance as part of your loan? (Value still to be determined)
YES / NO
Has there ever been an administration order against you? (If so, please attach details)
YES / NO
Have you ever been declared mentally unfit by a court of law?
YES / NO
SECTION 2: STUDY INFORMATION FAILURE TO COMPLETE THIS SECTION IN FULL MAY MEAN THAT YOUR APPLICATION WILL NOT BE PROCESSED
Course of Study: Degree / Diploma / Certificate
Name of course:
Campus: Buffalo City / Butterworth / Mthatha / Queenstown In 2014, I will be a ....... (please mark appropriate block with a 1
st
time student
Site:
P)
You will be registering for the 1 st time as a student in 2014
Senior student / Continuing Student
You are continuing your studies in 2014 and 2015
Final Year Student
You will write your final year examinations in November 2014 to graduate in May 2015
Post Graduate Student
You will be registered for a Honours, Masters or Doctoral programme in 2014 SECTION 3: STUDENT EMPLOYMENT INFORMATION
Are you currently employed (full-time or part-time): YES / NO (if yes, answer all questions in Section 3) Current employer: Position:
Gross Annual income (before deductions): SECTION 4: DETAILS OF PARENTS AND/OR GUARDIAN - PLEASE COMPLETE IN FULL A. FATHER / STEPFATHER (IF LIVING WITH YOU)
First Names (as per ID document): Surname:
ID No:
Status: Married / Single / Divorced / Separated / Deceased / Widowed (death certificate to be submitted) Gross Annual income (before deductions): Tel (Father):
E-mail:
Tel (Employer):
Any other income: YES / NO
Source:
Amount (yr):
B. MOTHER / STEPMOTHER (IF LIVING WITH YOU) First Names (as per ID document): Surname:
ID No:
Status: Married / Single / Divorced / Separated / Deceased / Widowed (death certificate to be submitted) Gross Annual income (before deductions) Tel (Mother):
E-mail:
Tel (Employer):
Any other income: YES / NO
Source:
Amount (yr):
C. GUARDIAN AND/OR GRANDPARENT (IF LIVING WITH YOU) Relationship: Guardian / Grandmother / Grandfather First Names
ID No:
(as per ID document) :
Surname:
Status: Married / Single / Divorced / Separated / Deceased / Widowed (death certificate to be submitted) Does the guardian support the family financially? If yes, complete section in full
YES / NO
Gross Annual income (before deductions): Tel (Guardian):
E-mail:
Tel (Employer):
Any other income: YES / NO
Source:
Amount (yr): 2
WALTER SISULU UNIVERSITY SECTION 5: NEXT OF KIN INFORMATION Please select a person that the university can contact in the event of an emergency Name of a relative not residing with you: Address:
Telephone:
City:
Province:
Relationship:
Postal Code: ID No:
SECTION 6: FAMILY DEPENDENTS (FAMILY STRUCTURE) This section must be completed by one of the applicants’ parents or his/her legal guardian. However, if the applicant is married or has supported him/herself for more than three years, or both the applicants parents are deceased and he/she does not have a legal guardian, then the applicant should complete this section. You must list all those who are dependent on the family’s total income declared in sections 3 and 4 (including parents and/or guardian). Please include yourself as the student. If you include students (other than yourself ), you must submit proof that they are registered at a university or FET college. ID copies must be submitted for all persons listed below. Please refer to points 1 - 13 on page 6 for documents required.
Name
Age
Identity Number
Present Activities (pre-school, school, student, adult) *
Relation to student (parent, sibling, child, spouse, other)
*If any of the persons noted above earns an income, this must be noted in the following sections: Identity Number (as above)
Income source (wages, salary, pension, child support, interest on investments, business profit)
Income per year **
** Proof of income must be supplied – if a person receives income from more than one source, these must all be listed. If income is from business profit, a copy of the financial statements submitted to SARS must be supplied. OFFICE USE ONLY (SECTIONS 3, 4, 5 AND 6) INCOME 1:
INCOME 2:
INCOME 3:
INCOME 4:
INCOME 5:
INCOME 6:
INCOME 7:
INCOME 8: SECTION 7: ANY ADDITIONAL INFORMATION
Is there any further information that we should know that will help us assess this application?
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WALTER SISULU UNIVERSITY SECTION 8: DECLARATION BY APPLICANT/STUDENT AND PARENT/SPOUSE/LEGAL GUARDIAN Failure to complete and sign BOTH Section A and B below may result in this application not being considered. SECTION A: Declaration by the student applying for financial assistance I declare and hereby certify that, through the signing of this application form, I have made complete and accurate disclosure of my family’s gross income (before deductions of tax or any other amounts). I understand that it is my responsibility to provide this information honestly and to the best of my knowledge, without prejudice. I understand that if the information provided by me is inaccurate, incomplete, not up-to-date or misleading (even if given to me in good faith and without negligence), the University or NSFAS will be entitled (in addition to instituting disciplinary procedures against me) to summarily cancel, reduce or revoke any financial assistance which it has provided, and/ or may require me to refund any such financial assistance, and/or refuse to allow me to register for any course or graduate until such assistance has been repaid in full. I consent to the University undertaking further credit checks or verification of the information provided herein. DATE:
SIGNATURE OF APPLICANT:
SECTION B: Declaration by parent/spouse/legal guardian I have checked all the information provided by my son/daughter/spouse in this application for financial assistance and confirm that it is accurate, up-to-date, complete and not in any way misleading. I have also read the declaration signed by my son/daughter/spouse as above, and I understand the consequences that may ensue if any of the information given in this application is inaccurate, incomplete, not up-to-date or misleading. In the interests of good governance and accountability for public funds, I agree that the University may request my individual profile from a credit bureau to verify my employment and income details. I CONSENT TO MY SON/DAUGHTER/SPOUSE SIGNING A LOAN AGREEMENT WITH THE NATIONAL STUDENT FINANCIAL AID SCHEME (NSFAS) ON ITS STANDARD TERMS AND CONDITIONS. DATE:
SIGNATURE OF PARENT/SPOUSE/LEGAL GUARDIAN:
PRINT NAME OF PARENT/GUARDIAN: GENERAL INFORMATION This form is to be returned to the Walter Sisulu University, Student Financial Aid Office by the 30 September 2013. The contact details of all the campus Financial Aid Office heads are provided below: Buffalo City Campus
043 – 702 9357
Ms Carol Joshua
Private Bag X1421, East London, 5200
Butterworth Campus
047 – 401 6203
Ms Noluthando Boya
Private Bag X3182, Butterworth, 4960
Mthatha Campus
047 – 502 2870
Mr Zazi Ntlati
Private Bag X1, Mthatha, 5117
Queenstown Campus
043 – 709 4000
Ms Pumela Ngele
Private Bag X1421, East London, 5200
All complaints can be directed to either the Campus Director on each campus or to the Office of the Chief Financial Officer. PLEASE TICK THE CHECKLIST TO MAKE SURE THAT YOU HAVE ATTACHED ALL THE NECESSARY DOCUMENTS: Student Certified copy of green bar-coded Identity Document (ID) of applicant Certified copies of birth certificates (preferably unabridged) or IDs of all members of the family and/or death certificates for deceased parents (first-time entering students ONLY) AND Salary/wages slips of both parents and/or other income of any other family member AND/OR Other proof of income (from informal trading, grants etc) If parents/guardian/spouse are/is unemployed, formal confirmation of this from an independent source is required 4
Office use only
WALTER SISULU UNIVERSITY IMPORTANT NOTICE: This is only an application and does not guarantee that you will receive a NSFAS loan or any bursary offered by the University. Previous or current funding does not guarantee future NSFAS funding. Read these notes carefully before completing the application form. Make sure that you read every section and that the information you provide is accurate. Please familiarise yourself with the NSFAS rules, terms and conditions published annually and available from the WSU Student Financial Aid Services Offices, or at www.wsu.ac.za NB: If students have not been advised of the success of their application for financial aid before registration, they are required to pay the minimum initial payment (as determined by the university) at registration. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
Incomplete application forms (including those with missing documents) will NOT be accepted. Postal applications will be accepted before the closing date if all required documentation is included. If documentation is not included, then the form will be returned and the application will be regarded as unsuccessful. WSU does not take responsibility for undelivered or missing postal applications. Only original application forms will be accepted and should be submitted at any one of the four campus Student Financial Aid Services Offices. Do not send original documents (birth certificates, IDs, salary advices), with the exception of affidavits. Attach recently certified (within the last 3 months) copies to the application form. Only original affidavits will be accepted. No emailed or faxed documents will be accepted. The closing date for all continuing students is the 30 September 2013. For students enrolling at WSU for the first time, the closing date for applications will be the 30 November 2013. No late or incomplete applications will be accepted, and these students will be responsible for their own student fees in 2014. Students who are granted a bursary from another organisation/institution are obliged to inform the campus Student Financial Aid Services Office. WSU reserves the right to withdraw any awards made to the student if the student receives a full bursary from another source. An award is granted for one year only. Non-South African citizens will not be considered. A student must have passed at least 60% of the registered subjects in the previous year to qualify for a NSFAS loan. A student may not receive a loan for longer than five years for a three year degree/diploma or six years for a four year degree. No funding will be awarded to students undertaking a BTech Degree (for a list of exceptions, please ask the Financial Aid Office). Any credit balances on student fee accounts will be sent to NSFAS as a first loan repayment. If an application is approved, and the student does not sign a contract after registration, the University reserves the right to withdraw the loan or bursary and the student will be responsible for his/her student fee account. Please make sure you receive a dated acknowledgement of receipt when you hand in this form at the campus Student Financial Aid Office.
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WALTER SISULU UNIVERSITY DOCUMENTS REQUIRED WHEN YOU APPLY FOR A NSFAS LOAN: Kindly send the following documents along with your application form: 1. If both parents are working, recent payslips not older than 2 months are required from each parent. If a parent is paid on a weekly basis, four consecutive payslips should be submitted. If a parent is paid on a two-weekly basis (fortnightly), then two consecutive payslips should be submitted. 2. If the parent/s is/are unemployed, a formal letter from the Department of Labour confirming unemployment status is preferred. This must be supported by an affidavit from the unemployed parent/s, stating how the family is being supported financially in the absence of salary or wages, and a 3 months bank statement. 3. If the parent/s is/are working in the informal sector where official payslips are not issued (e.g. street vending, or informal selling), the rand value of the income gained per month earned in this way must be stated in the affidavit and a three month bank statement should be submitted. 4. If the parent is employed as a domestic worker/gardener, then a letter from his/her employer is required stating the period of employment and the monthly salary. 5. If there is anyone in the family who is receiving a state pension or a child support grant, proof is needed. A certified copy of the most recent pension slip, pay point slip or an original three (3) month bank statement should be submitted. 6. If you are submitting an affidavit, please ensure that it includes your student number, your ID number, the ID numbers of your parents, and clearly states the value of any income received. Affidavits CANNOT be made by the student on behalf of their parents. Affidavits MUST be done by the parents / guardian. 7. If one/both parents is/are deceased, a copy of the death certificate should be submitted. 8. If the whereabouts of one/both parents is not known or if the parent has absconded or does not contribute towards the finances of the family, an affidavit is required from the parent/guardian that the students lives with. The parent writing the affidavit should not only indicate that he/she is single, but also that the other parent’s whereabouts are not known and that no financial support is being received. 9. If a student lives with his/her grandparents or another guardian, an affidavit from the grandparents or guardian is required. This affidavit needs to detail the whereabouts of the parents, any rand value amount of support given by the parent (even if there is none), and proof of income for the grandparents/guardian must be provided. 10. If a sibling (brother or sister to the applicant) over the age of 18 is still living with the family and unemployed, an affidavit from the sibling confirming his/her unemployment is required. If employed, salary advices or wages must be submitted and this is included in the gross income calculation for the family. 11. If a sibling is studying at a tertiary institution (other than WSU), proof of registration of that student is required. If the sibling is studying at WSU currently, his/her student number must be completed in Section 6 on the application form (under current activities). 12. Certified copies of identity documents (or birth certificates, preferably unabridged birth certificates) for every member of the household including the applicant should be submitted (first time applicants only). 13. If the student’s surname differs from that of his/her parents, an affidavit from one of the parents must be submitted stating why the surnames differ. 14. All copies of documents MUST be certified on the front face of the document.
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