EXTERNAL BURSARY APPLICATION FORM

Mtema Mashao Consulting Engineers Bursary Application Form

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INSTRUCTIONS REGARDING THIS BURSARY FORM It is not for company employees Use block letters to complete the application form Give concise answers and where applicable mark with X Attach certified copies as required. Incomplete or late applications will not be considered Applications should be forwarded to: HR Manager Mtema Mashao Consulting Engineers (Pty) Ltd P.O. Box 78 Nelspruit 1200

How did you know about our bursary?

Newspaper

University staff

Friend

Website

Career awareness

Other, specify

Mtema Mashao Consulting Engineers Bursary Application Form

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A. Title:

PARTICULARS OF APPLICANT . Surname: .

First names: Male Identity number Female

..

Race African Nationality Province Asian Coloured Indian White

Disability (If yes, attach proof.) Yes Marital status Postal Address . .. .. .. Postal code: Cellphone no.: Tel. no. (h): Tel. no. (w): Fax. no.: E-mail: Mtema Mashao Consulting Engineers Bursary Application Form Page 3 . . . Code: Code: Code: ... ... ... Postal code: . . . No . Home language Residential Address ..

B.

PARTICULARS OF UNDER / POSTGRADUATE FOR WHICH YOU WISH TO RECEIVE BURSARY

DIPLOMA

B-TECH

DEGREE

MASTERS

DOCTORATE

Student Number (if available): At which university / institution: .

Obtained admission:
YES NO

(If yes, attach proof)

Field of study: Major / main subjects:

Mark the academic year for which you are applying:

1 2 3 4

Short description or title of proposed research project (Masters Students only)

Details of the research proposal: Indicate the problem statement and the importance of your study (research) to society.

Mtema Mashao Consulting Engineers Bursary Application Form

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C.

EDUCATIONAL QUALIFICATIONS

National Senior Certificate: Year obtained: Aggregate symbol: Name of School: Results (if still in Grade 12, attach Grade 11 examination results):
Subject Symbol / Marks obtained

. .. ..

List all the diplomas / degrees obtained, including the present degree

Degree / Diploma

First registration

Year obtained

Full time / Part time

Name of Institution

If you are not currently enrolled at an educational institution, please indicate what you are doing at present.

......................... Mtema Mashao Consulting Engineers Bursary Application Form Page 5

D.

OTHER BURSARIES, SPONSORS AND/OR DONORS

Do you presently study with a bursary? YES / NO If yes, what is the name of the bursar? Annual value of the bursary Obligations of the bursary . .

Fathers occupation Mothers occupation Guardians occupation Mark your fathers monthly income group:
< R5 000 R5 001 - R10 000 R10 000 - R20 000 >R20 000
(Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.)

Mark your mothers monthly income group:

< R5 000 R5 001 - R10 000 R10 000 - R20 000 >R20 000
(Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.)

Mark your guardians monthly income group:

< R5 000 R5 001 - R10 000 R10 000 - R20 000 >R20 000
(Attach proof of income or sworn affidavit. Not required if employed by Mtema Mashao Cons Eng.)

How many other dependents are still at home/ Number of dependents at tertiary institutions Number of dependents still at school Do you have or have you received a study loan? YES / NO If yes, name of loan For what purpose

. .

.. ..

When did you get it?................................................................................. For how long are you intending to use it?................................................. How do you intend to repay it?..................................................................

If your bursary application is unsuccessful, what other options would you consider?....................................................................................................... Mtema Mashao Consulting Engineers Bursary Application Form Page 6

E.

DETAILS OF PARENTS / GUARDIAN / NEXT OF KIN

Title: Names: Identity No.:

..

Surname:

. .

Relationship:
Mother Father Other, specify

Postal Address . .. .. ..

Residential Address

. . .

Postal code: Cellphone no.: Tel. no. (h): Tel. no. (w): Fax. no.: E-mail: . . .

Postal code:

Code: Code: Code:

... ... ...

Mtema Mashao Consulting Engineers Bursary Application Form

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F.

MOTIVATION WHY YOU MUST BE CONSIDERED FOR BURSARY

Mtema Mashao Consulting Engineers Bursary Application Form

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G.

DOCUMENTATION

Please attach certified copies of the following:

Identity document of the applicant. Drivers license is not acceptable. Certificate of qualifications Recent academic records or school results Confirmation of registration or Admission letter Family income or an affidavit if parents are unemployed. Not required if parents are employed by Mtema Mashao Consulting Engineers. Research proposal (Masters students)

H.

DECLARATION

I hereby declare that the information provided in this application is correct and true in every respect. I am aware that failure to render correct information will lead to my application being disqualified. Therefore should I be awarded a bursary, I will abide by the regulations applicable.

Signature of applicant

..

Date

If minor, signature of parent / guardian .. Date .

Mtema Mashao Consulting Engineers Bursary Application Form

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