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APPLICATION FOR BURSARY Important: Not all who apply are interviewed. Please complete this form as thoroughly as possible as this is our only indication of your potential at this stage. Closing date strictly 31 July.

Surname

Mr/Miss/Ms

First names Intended field of study Major subjects (eg Business Economics and Economics) University or Technikon you wish to attend Study year next year (eg 1 of 4) Present postal address Postal Code Tel:Code

No.

Permanent postal address Postal Code Tel: Code

No.

Permanent home address Tel: Code

No.


CONFIDENTIAL


1 Personal details 1.1 Date of birth 1.2 Marital status (tick box)

Place of birth Single

Married

1.3 Nationality 1.4 Identity number 1.5 Home language

2 Citizenship Status 2.1 Period of residence in RSA 2.2 Registration as citizen under consideration

Yes

No

2.3 South African citizen

Yes

No

2.4 Immigration permit number

3 School education 3.1 Last/present school Name: 3.2 Highest standard passed Subject

Town Date Level (Higher/Standard/Practical)

Percentage/Symbol* Std 8 Std 9 Std 10

*Please indicate your latest school examination results ( and date) if your final matriculation results are not yet available.

4 Post-school training


University/college/other

Field of study

Study year

Course/Subject

Percentage/Symbol*

* Please attach copies of your progress reports.

5 Criminal record 5.1 Have you ever been convicted of criminal offence?

Yes

No

If so, give details

6 Work experience Name of employer

Nature of work

Period From To

Reasons for termination of service

7 Interests and hobbies Give details of sporting activities, group activities and hobbies with position attained (if any) 7.1 Sport


7.2 Outstanding achievements

7.3 Cultural activities (eg. Youth society, private clubs, etc.)

7.4 Hobbies (eg. Photography, electronics, etc.)

8 Relative in Eskom’s service 8.1 Name 8.2 Relationship 8.3 Where employed 8.4 Position 8.5 Tel:Code

Work No

9 Particulars of parent or guardian 9.1 Name 9.2 Relationship 9.3 Occupation 9.4 Employer 9.5Business address Postal code 9.6 Business tel: Code

Tel: No

10 General 10.1 Condition of health

Good

Fair

Poor


10.2 Give details and dates of operations, serious illnesses and/or mental and physical defects

10.3 Do you have a valid drivers licence ? Yes

No

State class of vehicle

10.4 Have you applied for or do you intend applying for another bursary?

Yes

No

If so, give details 10.5 Applications in response to Advertisement

Newspaper and date

Recommended

By

Careers exhibition

Venue and date

School/university

Name

Town/City

Other (specify) 10.6 Describe in your own words why you have chosen this of study and career.

I declare that the above particulars are true and correct and understand that any false or incomplete Information may constitute grounds to cancel immediately. Signature of applicant

Date

Signature of parent or guardian if applicant is minor

Date

NB 1. Responsibility for return of original documents or their loss cannot be accepted. 2. Your appointment at Eskom would be subject to a medical report.

Bursary Application Form -  

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