U P L A N D S C O L L E G E

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1 P/Bag X9909 White iver Mpumalanga, 1240 U P L A N D S C O L L E G E Co egistration number: 1997/018524/08 college@uplandscollege.org +27 (0) BUSAY APPLICATION Bursaries are awarded from limited funds designated by the College from the normal operational budget. These bursaries are intended to enable existing parents, who experience temporary financial difficulty, to keep their child at Uplands. In limited instances, bursaries are awarded to children of new parents who display high academic standards and who could otherwise not afford full fees. Bursaries are awarded for day scholar fees only and are normally not more than 25%. Bursaries are awarded on the following conditions, and are subject to annual review: 1. That the balance of the fees and all other costs are borne by you and paid timeously; 2. That you undertake to inform the Bursary Committee should there be a change in your financial situation so enabling you to bear the school fees without bursarial assistance; 3. That your child maintains his/her diligence and high academic standards, display exemplary behavior and attitude and participate willingly and positively in school activities; 4. That your child complies and identifies closely with the value system, norms and standards expected of Uplands College learners; 5. That you treat this in the strictest confidence. Please note: 1. This form is to be completed by the parent/s or legal guardian/s of the pupil. All particulars must be given in full. 2. A bursary is valid only until the end of the current year, and subject to annual review thereafter. 3. The application will be treated in the strictest confidence. A Bursary Committee will review your application. 4. It is the responsibility of the parents or legal guardians to provide proof of their annual income. The completed form, together with supporting documentation, must be returned to the Business Manager. The Bursary Committee meets bi-annually to review applications. T o d a y s T h i n k i n g C h i l d i s T o m o r r o w s A c h i e v e r Directors: Mr H ogerson (Chairman), ev d Canon A M Carle, Mr A Goss, Mr P W Hemus, Mr C S Zietsman, Mr N Adams, Mr C E Van Der Westhuizen, Mr G More, Mrs T J ussell, Mrs P L Brink, Preparatory Headmaster: Mr D A Ernstzen, Executive Headmaster: Mr A J I Clarke, Business Manager: Mrs N Lambrechts

2 Page 2 STUDENT INFOMATION Surname Initials Birth Date (dd/mm/yy) Physical Address First Name Other Names Gender Study Permit No (Foreign Students Only) Permit enewal Date (Foreign Students Only) Citizenship esidence Previous School Passport / SA ID No Parents Marital Status eligious Affiliation SCHOOL INFOMATION Entry Year Boarder or Day Scholar Entry Grade / Current Grade for existing pupils MOTIVATION Please provide any supplementary details that you would like to bring to the attention of the Bursary Committee. Your submission should include a short motivation as to why you think your child should be considered for a bursary. (If space is insufficient, attach another sheet).

3 Page 3 GUADIAN INFOMATION Father / Principal Guardian Mother / Secondary Guardian Title Surname First name Initials Identity or Passport Number elationship to the Child Box / Street Town Postal Address Country / Province Code esidential Address Home Telephone Cell Number Address Employer Work Telephone Fax Position at Work CONFIDENTIAL ETUN BY PAENT / GUADIAN a) Income of guardians by way of salaries, bonuses, wages, directors earnings, pensions etc. Please attach supporting documentation (salary advice etc.). Divide annual amounts (e.g. bonuses) by 12 to get average monthly income. Nature of amount or Gross Monthly Net Monthly benefit received Income Income Father / Principal Guardian Mother / Secondary Guardian Total b) Annual income from own business, trade, profession or farming. Please attach financial statements as proof of income. Nature of business Gross Monthly Net Monthly trade Income Income Father / Principal Guardian Mother / Secondary Guardian Total

4 Page 4 c) Any other income e.g. maintenance if divorced, rent from property, interest / dividends from investments, disability / old age pension. eceived by way of Gross Monthly Net Monthly (interest, rent etc.) Income Income Father / Principal Guardian Mother / Secondary Guardian Total TOTAL INCOME FOM ALL SOUCES d) Please state the annual amount that you will be able to contribute for each child towards school fees at Uplands College: First child Second child (per annum) (per annum) e) Statement of monthly household budget Expense item ental / Bond installment Water, electricity and rates Vehicle (Balance ) Lease / HP installment Vehicle running expenses Groceries and provisions Clothes: Accounts Credit cards Medical Telephone Any other expenses: Monthly amounts / installments TOTAL EXPENSES

5 Page 5 DECLAATION OF GOOD FAITH We/I hereby declare that we are/i am not in a position to fully provide for the educational needs of the child(ren) mentioned above, without assistance. In making this request, we/i have not withheld any information concerning our/my circumstances and all information furnished in this application form is correct. We/I agree that, should it, at any stage, be ascertained that the information provided by us/me is inaccurate, the financial assistance which may have been granted will be cancelled and the amount which has already been paid out, will be recovered from us/me. We/I undertake to advise the Bursary Committee timeously of any changes to our/my circumstances, which would have a bearing on their assessment of our/my eligibility for a bursary. Sign: Principle Guardian Sign: Secondary Guardian Date: