Bursary application form Please return this application form to the address below: Career Wise (Pty) Ltd PO Box 30632, Braamfontein,

2017 Fax: 086 609 7183 e-mail: applications@careerwise.co.za

Opening date: 1 March annually Closing date: 31 August annually Please note that if you have not received notification by 30 November your application was unsuccessful

Please tick (✓) the course you wish to study, or are studying:

( ) Information systems

( ) Computer science

( ) Electronic or electrical engineering (Light current only)

( ) Computer engineering

Please use a black pen

Please tick (✓) to indicate your current status: ( ) Presently in grade 12 ( ) Matriculated but not yet at tertiary ( ) Currently at tertiary: ( ) University ( ) University of technology A. Personal Details

Please glue a

passport size

photo here

(Head &

shoulders)

Male ( ) Female ( ) Surname: ..................................................................................................................................................................................... Other names in full: .....................................................................................................................................................................

1. Currently at the following University / University of technology

.................................................................................................................................................................................................................................................................................. 2. Name of the proposed university: (If not yet at University / University of technology)

.................................................................................................................................................................................................................................................................................. 3. Name and address of your present or last school:

..................................................................................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................................................

Postal code:........................................................................................................

School telephone no: ............................................................................. Dialling code:......................................................................

Permanent home address in full:

..................................................................................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................................................

Postal code: .......................................................................................................

Home telephone no:....................................................................................... Dialling code: ...........................................................................................................

Career Wise (Pty) Ltd Reference Number: 217014

PO Box 30632, Braamfontein, 2017

Bursary application form (cont.) 4. Your cell phone number. ...................................................................................................................................................................

5. Alternative cell phone number. .........................................................................................................................................................

6. Person whom we can telephone to contact you urgently:

Name: ....................................................................................................

Telephone no: ........................................................................ Dialling code: ..........................................................................

7. Name of parent or guardian:

Father: ................................................................................................................. Occupation: .............................................................................................. Place of work: ............................................................................................................

Telephone no: ........................................................................................... Dialling code: ..............................................................................................................

Mother: ....................................................................................................

Occupation: .............................................................................................. Place of work: ............................................................................................................

Telephone no: .......................................................................................... Dialling code: ...............................................................................................................

8. Home Language: .....................................................................................

9. Place of birth: .......................................................................................... Date of birth: ..............................................................................................................

10. Age in years this December: ................................................................ Identity Number: ......................................................................................................

11. Marital status ( ) Single ( ) Married

12. SA citizen ( ) Yes or ( ) Permanent resident

13. Do you suffer from a chronic or physical handicap? ( ) Yes ( ) No

If yes, please give brief details:

............................................................................................................................. ............................................................................................. ........................................................

............................................................................................................................. ..................................................................................................................................................... 14. Have you been convicted of any crime/crimes? If yes, please state which crimes you have been convicted of:

..................................................................................................................................................................................................................................................................................

..................................................................................................................................................................................................................................................................................

B. Education

1. Name of secondary schools attended:

Name of school Dates attended Standards completed

Please give grade 11 and 12 results: Add additional subjects not listed

Subject Achievement level Current position in class

Grade 11 Grade 12

English

Mathematics

Reference Number: 217014

Bursary application form (cont.)

Mathematics 3

Mathematics literacy

Physical science

Other

Other

Other

Other

Other 2. Have you completed matric? ( ) Yes ( ) No

If yes, please complete the following:

Name of examination: ...........................................................................................................................................................................................................................

Year of exam: ..........................................................................................................................................................................................................................

Final matriculation results:

Subject HG / SG Symbol Subject HG / SG Symbol

3. If you are repeating some of your Matric examinations, please complete the following:

Name of centre / school you are attending : ...................................................................................................................................................................................

Examination date: ...........................................................................................................................................................................................................................

Subject Achievement level Achievement level Symbol

Reference Number: 217014

Bursary application form (cont.)

4. Have you undertaken any post-matric studies excluding full-time university? ( ) Yes ( ) No

If yes, please give details of course you are studying at present and qualifications (if any) obtained:

..................................................................................................................................................................................................... .............................................................................

................................................................................................................................................................................ .................................................................................................. 5. Are you attending university: ( ) Yes ( ) No

If yes, please completes the following:

Degree which you hope to obtain: ............................................................................................................................................................................................................

Present year of study: ............................................ Year which you started your degree: ...........................

* Please attach your full academic record to date or your application will not be considered

C. Achievements

1. Give details of all your activities at school and university or in the community, and your role in them: eg. Leadership, sport,

cultural, etc. (Please include all details as we use this information for your interview CV for company bursary interviews)

School / University / Community / Academic / Sport / Cultural

2. Give details of any activity (academic or otherwise) in which you have done well either at school and/or university,

and have maybe achieved awards: (Please attach a separate sheet of paper if this space is not sufficient)

3. Have you had a part-time job? ( ) Yes ( ) No

If yes, please describe what you did and where you worked

Reference Number: 217014

Bursary application form (cont.)

D. Career

1. Where did you find out about this bursary/scholarship?

( ) Newspaper / magazine ( ) Career talks ( ) Family / friends ( ) School / teacher

( ) University handbooks ( ) Career exhibitions

2. Are you in receipt of any other scholarship, bursary or loan? ( ) Yes ( ) No

If yes, what is the name of the award? ...........................................................................................................................

Does it carry an employment obligation? ( ) Yes ( ) No

3. Give details of working experience since leaving school if applicable:

Name of organisation Date Type of work Reason for leaving

From To

4. Write a brief statement setting out clearly why you have chosen this degree and how you intend to use it after graduation:

Signed : ............................................................................................................................Date : .................................................................................................

I declare that to the best of my knowledge all the information on this form is true and correct

Notes and instructions

Please read these notes and instructions carefully before completing this form. Be sure to read every section and that

the information you provide is accurate. 1. Application forms that are incomplete will be disregarded. Please ensure that you attach proof of academic results: current

matriculants do not need to provide preliminary results – final grade 11 will suffice. 2. Applications open 1 March and closes on 31 August annually for bursaries for the following year. 3. Bursaries will only be allocated for next year. 4. You must supply all the information requested, or explain why you cannot provide it. 5. Applicants applying for bursaries with less than a B symbol in mathematics and science will not be considered. 6. Do not send original documents, please attach copies. 7. A passport size photograph of the applicant must be attached to the top right-hand of the front page. 8. It is your responsibility to apply for entrance to university and for other options for financial support. We recommend

that you apply to at least two universities and for many funding options/bursaries. 9. Please note that if you have not received feedback from us by 30 November note that your application was unsuccessful