STRATEGIC HUMAN CAPITAL
EXTERNAL BURSARY APPLICATION FORM / Form No. RW SHC37001 F
Rev. No. 00
Date: July 2013
Rand Water Capacity Building,
522 Impala Road, Glen Vista, 2058
PO Box 1127, Johannesburg, 2000, South Africa
Tel: (+27 11) 682 0586, E-mail address:
NOTE / Proof of registration/acceptance at a South African tertiary institution that has been registered & accredited by the Council of Higher Education (CHE)Attach certified copy of identity document
Attached Latest Academic record/results
In terms of Rand Water’s External Bursary program, first preference will be given to previously disadvantaged communities, people with disabilities and females
BURSARY DISCIPLINES TO BE AWARDED: /
- BSc Electrical Engineering (heavy/light current)
- BSc Computer Science
- PHD / MPH Public Health
- National Diploma / BSc Bio Chemistry
- National Diploma / B-Tech Analytical
- BSc Chemical Engineering
- BSc Civil Engineering
- BSc Mechanical Engineering
- Diploma Mechanical Engineering
- BSc / BCom Information Technology
- BCom Finance
- BCom Auditing
- BCom Financial Information Systems
- B-Tec Forensic
- Degree Bachelor of Commerce
- Degree Bachelor of Law
- Degree Masters of Law
- Degree Doctorate of Law
- Degree Financial Accounting
- National Diploma Environmental Science
- National Diploma Safety Management
- National Diploma Water Care
- National Diploma / BCom Human Resources Management
1.PERSONAL DETAILS:
Surname: / First Names:
Postal Address:
Physical Address:
Telephone Number / Cell
Identity Number / - / - / Gender / F / M
Are you a South African Citizen? / YES / NO / Which SA Province do you come from?
Which SA City do you come from?
What is the name of your municipality?
Do you have any criminal Record? / YES / NO / If Yes please specify:
Race / A / B / C / W / Do you have any physical disability? / YES / NO
Cross whichever is applicable / Declaration is optional :
2.HIGH SCHOOL ACADEMIC RECORD:
Name of School Matriculated / Province situated
Year Matriculated / Aggregate Symbol / Exemption / YES / NO
SUBJECTS: / GRADE :
NB: Please attach official statement of Result / 1
2
3
4
5
6
7
8
3.DETAILS OF PARENT / GUARDIAN :
PARENT / GUARDIAN 1:
Mr / Mrs / Ms / Surname:
First Names:
Identity Number / - / - / Gender / F / M
Employer (If applicable)
Employer Address
PARENT / GUARDIAN 2 :
Mr / Mrs / Ms / Surname:
First Names:
Identity Number / - / - / Gender / F / M
Employer (If applicable)
Employer Address
4.QUALIFICATION & INSTITUTION OF LEARNING DETAILS :
YEAR OF STUDY / Year 1 / Year2 / Year3 / Year4
Specify the Field
(e.g. ND, BSc. etc.)
Institution Enrolled / Intend Enrolling
Have you already been admitted for proposed study? / YES / NO
Have you already been admitted at a Residence / YES / NO
5.EXTRAMURAL AND OTHER RELATED INFORMATION:
5.1 GIVE A SET OF YOUR
ACHIEVEMENTS / LEADERSHIP ROLES :
(School / University/ Community / Academic/Sport/Cultural)
5.2WHAT ARE SOME OF YOUR HOBBIES / INTERESTS?
5.3WHERE DID YOU FIND OUT ABOUT THE RAND WATER BURSARIES?
5.4MOTIVATION:
In your own words, state the motivation for Rand Water to consider offering you a bursary?
(You are free to attach a written addendum)
6. DECLARATION
If this application is successful, I shall accept that the bursary will be subject to the relevant conditions contained in the Rand Water External Bursary Contract terms and Conditions.
Student’s Signature / Date / ………/ ………/ 20…….
If under 21 years of age, parent / legal guardian to complete.
Parent / legal guardian Name / Of :
Signature / Date: / ………/ ………/ 20…….
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