Myrtle L Aron Bursary FundApplication Form

CLOSING DATE FOR THE APPLICATION: 31 JANUARY, OF EVERY YEAR

THE BURSARY IS AVAILABLE FOR STUDENTS WHO HAVE SUCCESSFULLY COMPLETED THEIR 2ND OR 3RD YEAR OF A SPEECH PATHOLOGY AND AUDIOLOGY DEGREE. ONLY STUDENTS STUDYING THE 3RD OR 4TH YEAR CURRICULUM OF THEIR DEGREE WILL BE AWARDED THE BURSARY.

PERSONAL DETAILS

SURNAME
FIRST NAME
GENDER / MALE / FEMALE
AGE
ID NUMBER / PLEASE INCLUDE A CERTIFIED COPY OF YOUR ID
NATIONALITY
MARITAL STATUS
NO OF DEPENDANTS
PREVIOUSLY
DISADVANTAGED / YES / NO
WHERE DO YOU STAY WHILE
STUDYING?
HOME ADDRESS
CODE:
POSTAL ADDRESS
CODE:
TELEPHONE NUMBER
CELL NUMBER
EMAIL ADDRESS

BANKING DETAILS:

NAME OF ACCOUNT
HOLDER
NAME OF BANK
BRANCH AND CODE
ACCOUNT NUMBER

UNIVERSITY DETAILS

UNIVERSITY
UNIVERSITY DEPT TEL
NUMBER
PRESENT YEAR OF
STUDY
DATE OF FIRST YEAR OF
REGISTRATION

HOW DID YOU HEAR ABOUT THE MYRTLE L ARON BURSARY FUND?

______

ARE YOU A SASLHA STUDENT MEMBER? ______

HAVE YOU APPLIED FOR ANY OTHER BURSARY, GRANT OR LOAN? YES / NO

IF SO STATE THE NAME OF THE ORGANISATION TO WHICH YOU HAVE APPLIED:

______

WHEN DID YOU SUBMIT YOUR APPLICATION TO THEM? ______

AMOUNT APPLIED FOR: ______

WAS YOUR APPLICATION SUCCESSFUL? YES / NO

HOW DO YOU FINANCE YOUR UNIVERSITY EDUCATION?

______

MOTIVATE WHY YOU BELIEVE YOU DESERVE THIS AWARD?

______

Give a brief description of yourself, your hobbies and your community involvement.

______

Where do you see yourself 5 years after you have graduated?

______

Matriculation details:

School: ______

Year of Matriculation: ______

Please enclose a certified copy of your matriculation certificate.

Post Matriculation details:

Describe what you have done since matriculation. Include forms of occupation, attendance at Universities, Colleges.

YEAR / NAME OF INSTITUTION / COURSE OF STUDY OR OCCUPATION

Details of subjects studied and grades obtained:

FIRST YEAR: LAST SEMESTER

SUBJECTS / GRADES

SECOND YEAR: LAST SEMESTER

SUBJECTS / GRADES

THIRD YEAR: LAST SEMESTER

SUBJECTS / GRADES

FOURTH YEAR: LAST SEMESTER

SUBJECTS / GRADES

Please enclose certified copies of the most recent certificate of your subjects and grades

Please enclose two testimonials:

  1. From any academic staff member of the department of Speech Pathology and Audiology/Communication Pathology
  2. From any other person or organization you belong to

I,______hereby declare that all the above information is accurate.

I understand that the Council’s decision is final.

Signed on this ______day of______2______

______

Signature

COMPLETED FORMS CAN BE SENT VIA THE FOLLOWING:

MAIL TO:EMAIL TO:

SASLA

PO BOX 2127FAX TO E-MAIL: 011888 9624

Cresta

JOHANNESBURG

2118