TO ALL APPLICANTS FOR BLIND SA STUDY BURSARIES
Dear Applicant
Enclosed please find the following documents:
(a)Application form for a Blind SA Study Bursary;
(b)Rules and procedures for the allocation of Blind SA Study Bursaries;
(c)Blind SA Membership Application Form; and
(d)Medical Form.
We request the following:
- Please return the completed form to our Head Office, together with the results at your disposal of your academic year, to reach us before or on 15 November of that year.
- The results of your final examination for your academics year should be forwarded to us as soon as they become available, to reach us before or on 15 January the following year. If these results are not available at this date, please contact our Head Office immediately.
- All applications must be accompanied by the attached medical certificate. This form must be completed in full by an eye specialist.
- Students who complete their studies must send their final results to the Blind SA Head Office. Students who neglect to send their results or fail in the final year will be held responsible for the last disbursement.
NB: Applicants who do not strictly comply with the above procedures, will not be considered for Blind SA study bursaries.
Please note that for your convenience, enclosed documents are also available on our website at Students, who have their own access to the Internet, are welcome to download those forms and complete them in their own time. Completed forms may be sent to Blind SA via e-mail to .
On behalf of Blind SA, we would like to extend to you our very best wishes and we trust that the final results at the end of the academic year will meet your expectations.
Kind regards
Blind SA
(a)APPLICATION FOR A BLIND SASTUDY BURSARY
1. RELEVANT INFORMATION
1.1 This form is also available in Braille.
1.2 The closing date for applications is 15 November of each year.
1.3 Bursaries are usually allocated for the full normal duration of a course. You should however apply annually for the continuation of your study bursary. You will be supplied with the necessary forms annually.
1.4 Disbursement of study bursaries will only take place after receipt of registration details.
2. ADDITIONAL DOCUMENTATION
PLEASE ensure that the following documentation is attached to your application:
2.1 Proof of your most recent academic achievements.
2.2 As motivation, a letter of recommendation from e.g. a dean or principal etc may be attached to your application.
2.3 Proof of registration, together with student number, if available.
2.4 Medical certificate, if applicable.
2.5 Application for membership of Blind SA.
3. COMPLETION
3.1 Please answer ALL questions IN FULL.
3.2 Please complete this form in block letters, or provide typed or brailled information, numbered strictly according to the numbering used on this application form.
4. PARTICULARS
4.1 Family name:4.2 Title:
4.3 First names:
4.4 Identity number:
4.5 Postal address:
4.6 Street address:
4.7 Contact number:
4.8 E-mail address:
4.9 Are you blind/partially sighted?:
4.10 Highest academic qualification:
4.11 Name and contact numbers of principal / contact person of last school / institution attended:
4.12 Prospective career:
4.13 Name and address of prospective training centre:
4.14 Prospective study course:
4.15 What is the normal duration of the course?:
4.16 If you are already studying at a tertiary institution:
4.16.1 When was your first year of study?:
4.16.2 Which academic year will you be completing in 2007?:
4.17 Will you be studying full-time or part-time?:
4.18 If you are in receipt of any other bursary/bursaries in respect of the period for which you are making this application, please state value and source:
4.19 Date of commencement of course:
4.20 Blind SA Membership number:
5. BANKING DETAILS
Should a Blind SA Study Bursary be awarded to you, you are welcome to fill in the section below in order to expedite payment of funds.
5.1 Name and initials of account holder:5.2 Name of bank:
5.3 Account number:
5.4 Type of account (savings, transmission, cheque, etc):
5.5 Name of branch:
5.6 Branch code:
6. You are kindly requested to notify the Blind SA Head Office immediately if any of the information as filled in by you on this form, should change.
SIGNATURE OF APPLICANT:DATE: / PLACE:
(b) BLIND SASTUDY BURSARIESRULES AND PROCEDURES
1. The Organisation awards study bursaries on the recommendation of its Committee for Student Affairs.
2. Bursaries are available to all blind and visually impaired persons and the sighted children of visually impaired parents who are members of an affiliate of Blind SA.
3. Bursaries will be considered on merit for the obtaining of post graduate and/or additional qualifications.
4. The minimum requirement to qualify for a Blind SA study bursary is Grade 12 or a similar qualification.
5. Part-time students can also apply for a Blind SA study bursary.
6. Bursaries are allocated for the full normal duration or for the remaining portion of a proposed study course. If justified by circumstances, the Committee may deviate from this rule.
7. The bursary will be continued for a bursary holder who has been promoted to the next academic year and who has properly completed and submitted the form “APPLICATION FOR THE CONTINUATION OF A BLIND SA STUDY BURSARY” in time.
8. A bursary holder who is not promoted to the next academic year must submit a written motivation for the continuation of his bursary.
9. Any changes to study course, study institution or extension of study periods should immediately be brought to the attention of the Committee for Student Affairs and should be in writing. Students who do not comply with this requirement, may be held responsible for the full repayment in respect of all monies paid out to them by Blind SA.
10. If, for any reason, a student discontinues his/her studies, he/she may be held responsible for the full repayment of all monies awarded to him/her by Blind SA. Should there be uncertainty over the continuation of a bursary, the matter will be investigated and finalised by the Committee for Student Affairs.
11. Should a student abandon his/her studies in the course of a year or fail to take his/her examinations, he/she shall be obligated to repay the amount disbursed in respect of that year, or to make arrangements for repayment within a reasonable period.
12. Students who complete their studies must send their final results to the Blind SA Head Office. Students who neglect to send their results or fail in the final year will be held responsible for the last disbursement.
13. From time to time the Head Office will decide on the maximum annual allocation for study bursaries.
14. Applications which do not strictly comply with the prescribed requirements, will not service before the Committee.
REVISED: MAY 2005
(c) BLIND SA APPLICATION FOR MEMBERSHIP
1. Surname:2. First Name/Names:
3. Preferred Name:
4. Title:
5. Gender: Female / male:
6. ID Number:
7. Date of birth:
8. Postal Address:
9. Residential Address:
10. Telephone: / Home: / Cell:
Fax:
11. E-mail:
12. Vision: Blind / Partially Sighted / Sighted:
13. Medium(s) of Communication: Braille / ink print / audio / electronic / large print:
SIGNATURE:
DATE:
FOR OFFICE USE
Date of approval:Membership Number:
Date of Transfer:
Transferred to:
Transferred from:
(d) STATEMENT OF EYE CONDITION OF PROSPECTIVE BURSARY APPLICANTS
NB: THIS FORM IS TO BE COMPLETED BY A REGISTERED OPTOMETRIST OR OPHTHALMOLOGIST.
GUIDELINES FOR EXAMINATION
1. The visual acuity should be tested using a Snellen Chart with the best possible correction in each eye. Finger counting should be done with a contrasting background.
2. Field of vision should be tested using a 5mm target at 1 meter (or equivalent).
DETAILS OF APPLICANT
Surname:First name(s):
Address:
Contact number(s):
Identity number:
DETAILS OF OPTOMETRIST/OPHTHALMOLOGIST
Name:
Address:
Contact number(s):
EYE CONDITION
1. Cause of visual loss:
2. Visual acuity – With correction:
Left eye: / Right eye:
DATE:
SIGNATURE: APPLICANT:
OPTOMETRIST / OPHTHALMOLOGIST: