GIBB BURSARY APPLICATION - EXTERNAL
TRN003(a)
FULL NAMES:
Address
Province
Student Number /

ID No

E-Mail Address / Contact No
Next of Kin / Next of Kin Contact No
FOR THE PURPOSES OF DEMOGRAPHIC STATISTICS, HOW DO YOU CLASSIFY YOURSELF?
Male / Female / African / Coloured / White / Indian
Are you a person with a disability? / Yes / No / If yes, please specify the nature of disability
QUALIFICATION DETAILS
Institution Name
Qualification Type / Diploma / Degree / Post Graduate Degree
Qualification Title
Current Year of Study / Expected Completion Date
BURSARY AMOUNT REQUESTED
Category / Amount / Category / Amount / Category / Amount
Tuition / Books / Accommodation
Travel / Other – Specify (1): / Other – Specify (2):
Total Amount Requested:
OTHER FINANCIAL ASSISTANCE
Have you applied for additional funding from any other sources? (Please note that failure to document this may result in your bursary offer being withdrawn) / Yes / No
If the answer to the above is yes, please indicate the amount and source
Amount / Source
Amount / Source
APPLICANT SIGNATURE / DATE

APPROVAL TO PROCEED (FOR OFFICIAL USE ONLY)

Category / Amount Approved / þ / Category / Amount Approved / þ / Category / Amount Approved / þ
Tuition / Books / Accommodation
Travel
Total Amount Approved:

Bursary Committee Approver

NAME /

SIGNATURE

/

DATE

Bursary Committee Approver

NAME / SIGNATURE /

DATE

TRN003(a) - Bursary Application - External.doc Page 2 of 2 Feb 2015

Version 5