SHEILA BRAND EDUCATIONAL TRUST REGISTRASIE NOMMER MT 13770/2003 AANSOEKVORM
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1 SHEILA BAND EDUCATIONAL TUST EGISTASIE NOMME MT 13770/2003 AANSOEKVOM SHEILA BAND EDUCATIONAL TUST EGISTATION NUMBE MT 13770/2003 APPLICATION FOM
2 HIEDIE VOM MOET VOLLEDIG IN SWAT INK VOLTOOI WOD / THIS FOM MUST BE FULLY COMPLETED IN BLACK INK AFDELING A PESOONLIKE INLIGTING VAN APPLIKANT Nota: Dui asb met n kruisie(x) aan waar van toepassing STUDENTE NOMME STUDENT NUMBE Surname Van Titel ID nommer Title ID Number Kontaknommers Tuis Contact Numbers Home Huidige Kontakadres Current Contact address Adres ten tye van studie Address while studying Volle name Full names SECTION A PESONAL INFOMATION OF APPLICANT Note: Please mark with a cross (x) where applicable Selfoon Cell phone SA Burger SA Citizen Adviseer asb. hoe studies tot dusvêr befonds is of beoog word om te befonds (hierdie beurs uitgesluit): Please advise funding of studies so far or intention to fund (this bursary excluded): Lenings: Loans: Instansie Institution Jaarliks beskikbaar? Available annually? Ja Yes Beurse: Instansie Jaarliks beskikbaar? Ja Bursaries: Institution Available annually? Yes Alternatiewe opsies beskikbaar (bv banklening deur ouer) Alternative options available (e.g. bank loan by parent) Ja Yes Nee No Nee No Nee No AFDELING B : GESINSINKOMSTE SECTION B : FAMILY INCOME Nota: Dui u ouers se inkomste aan soos dit tans is; u persoonlike inkomste en, indien self getroud, ook u gade. Bewys van inkomste moet aangeheg word. Verwys na dokumente wat hierdie aansoek moet vergesel. Inligting van Voorletters Initials Van Surname Note: Show your parents' current income; your personal income, and if married yourself, your spouse as well. Proof of income must be attached. Please refer to documents required in support of this application. Beroep Occupation Information of Vader Father Moeder Mother Voog Guardian U inkomste/ Your income Gade Spouse Inligting van broers of susters wat afhanklik is van die familie inkomste Detail of siblings who are dependent on the family income Bruto inkomste p.m. Gross income p.m. Bruto inkomste p.j. Gross income p.a. Totale afhanklikes in gesin Total of dependents in family Naam/Name Skool/School Bedrag/Amount Universiteit/University Bedrag/Amount AFDELING C : BYKOMENDE INLIGTING Nota: Gebruik addisionele bladsye indien nodig Staaf asseblief waar moontlik Leierskapposisies beklee / Leadership positions SECTION C : ADDITIONAL INFOMATION Note: Use additional pages if necessary Please attach proof where possible Besonderhede van deelname in sport / Details of participation in sports Besonderhede van deelname aan kultuuraktiwiteite / Detail of participation in cultural activities Bydrae tot gemeenskapsdiens / Contribution to community services Enige ander inligting wat u wil verstrek ter motivering van u aansoek heg aan by hierdie aansoek sien Afdeling G hieronder Any other information that you want to provide to motivate your application. attach it to this application see Section G below
3 AFDELING D INLIGTING TEN OPSIGTE VAN BEPLANDE STUDIES SECTION D INFOMATION ELATING TO PLANNED STUDIES Naam van Instansie Kursus Duur van Kursus Huidige studiejaar Name of Institution Course Course Duration Current year of study AFDELING E OPSOMMING VAN KUSUSFOOIE SECTION E SUMMAY OF COUSE FEES egistrasiegelde egistration fee Klasgelde Tuition fees Totaal Afdeling E Total Section E AFDELING F OPSOMMING VAN ANDE UITGAWES AFDELING F SUMMAY OF OTHE EXPENSES Boeke Books Internet Internet ekenaarsentrum Computer centre Fotostate Photocopies Verblyfkoste Accommodation fees (spesifiseer) (specify) Privaat Private Koshuis esidence eiskoste Travelling costs Etes (indien nie ingesluit by verblyf) Meals (only if not included in accommocation fees) Sakgeld Pocket money Ander uitgawes (spesifiseer) Other expenses (specify) Totaal Afdeling F Total Section F Plus:Totaal Afdeling E Plus:Total Section E TOTALE FINANSIËLE BEHOEFTES TOTAL FINANCIAL NEEDS
4 AFDELING G MOTIVEE U EDE OM HIEDIE STUDIE IGTING TE VOLG EN WAAOM HIEDIE BEUS AAN U TOEGEKEN MOET WOD Nota: Gebruik addisionele bladsye indien nodig SECTION G MOTIVATE YOU EASON FO FOLLOWING THIS COUSE AND WHY THIS BUSAY SHOULD BE AWADED TO YOU Note: Use additional pages if necessary
5 AFDELING H : BELANGIKE INLIGTING EN VOOWAADES NOTA: In geval van n teenstrydigheid tussen die Afrikaanse en Engelse weergawes van hierdie aansoekvorm, sal die Engelse weergawe voorrang geniet NOTA: Neem ook kennis van die kriteria hieronder uiteengesit van toepassing op die toekenning van die beurs. SECTION H : IMPOTANT INFOMATION AND CONDITIONS NOTE: In the event of a conflict between the Afrikaans and English versions of this Application Form, the English version will enjoy preference NOTE: Also note the criteria hereunder applicable to the allocation of the bursary. SLUITINGSDATUM VI ALLE AANSOEKE IS: 31 Augustus 2018 CLOSING DATE FO ALL APPLICATIONS IS: 31 August 2018 Die korrekte gewaarmerkte dokumentasie hieronder vereis as bewys van inkomste moet verskaf word. The correct certified documentation required hereunder as proof of income must be supplied. Indien werkloos, heg asb n beëdigde verklaring aan waarin u enige oorlewingsgeld/toelaag verklaar bv onderhoud, beleggings, rente, familieskenkings, UIF, ens. Grootouers word slegs as wettige voogde aanvaar indien die gepaste bewyse (bv doodsertifikaat van ouer) aangeheg is. Die reg word voorbehou om hierdie aansoek/toekenning te kanselleer en enige fondse reeds oorbetaal, terug te vorder, indien valse of onjuiste inligting verstrek word of enige ander beurs, ongeag die bedrag, op enige stadium in dieselfde studiejaar aan die student toegeken word. Indien n student se akademiese vordering gedurende of aan die einde van n gegewe jaar in die uitsluitlike diskresie van die Trustees van die trust nie bevredigend is nie, kan enige toekennings in daardie jaar gestaak word en/of die beursbedrag in daardie jaar en enige vorige jaar reeds toegeken, word n lening en is dan ten volle terugbetaalbaar op aanvraag. Voortsetting van toekeninngs in opvolgende akademiese jare hang af van studente se voortgesette finansiële behoeftigheid, akademiese prestasie asook sy/haar algemene gedrag, in die uitsluitlike diskresie van die Trustees van die trust. Studente moet elke jaar skriftelike bewys lewer van sy/haar voortgesette finansiële behoeftigheid Dit is belangrik om te let dat beurshouers nie afbreuk mag doen aan die gees van uitnemendheid en mensheid wat die Fonds wens te vereenselwig met beurse uit die Fonds nie. Hierdie beurs mag nie, sonder die toestemming van die Trustees, gelyktydig gehou word met ander beurse en toekennings nie. Ten opsigte van Matriekulante se aansoeke: - Die aansoek moet vergesel word van n motiveringsbrief deur die aansoeker se betrokke skoolhoof; welke motivering moet insluit waarom die skoolhoof die aansoeker as n geskikte kandidaat vir die beurs beskou. Alle aansoekers moet beskikbaar wees vir n persoonlike onderhoud met die trustees op eie koste, indien daartoe versoek word. DOKUMENTE WAT AANGEHEG MOET WOD BY HIEDIE AANSOEK If unemployed, please attach a sworn affidavit, and declare your survival money/grant e.g. maintenance, investments, interest, family donations, UIF, etc. Grandparents will only be accepted as guardians if the relevant proof (e.g. death certificate) is included. The right is reserved to cancel this application/award and reclaim any funds already paid out if false or incorrect information is supplied or in the event of another bursary, irrespective of the amount, being awarded to the student at any time during the same year of study. Should the academic progress of a student in the sole discretion of the Trustees of the trust not be satisfactory during or at the end of a specific year, any allocations in that year could be stopped and/or allocations in respect of the bursary already made in that year and any previous year become a loan; repayable on demand. Continuance of allocations in following academic years depend on the student's continued financial need, the academic progress of a student as well as his/her general demeanour, in the sole discretion of the Trustees. Students must submit written proof of his/her continued financial need each year It is important to note that a bursary holder must not disparage the goodwill of excellence and humanity that the Fund wish to associate with bursaries from the Fund. This bursary may not be held concurrently with other scholarships, bursaries or awards, without the consent of the Trustees. With regard to applications by Matriculants: - The application to be accompanied by a motivational letter by the school principal of the applicant; which motivation should mention why the principal regard the applicant a worthy candidate for this bursary. All applicants must be available for a personal interview with the trustees at their own cost, if so requested. DOCUMENTS TO BE ATTACHED TO THIS APPLICATION Dokumentasie hierbo na verwys waar toepaslik; Documentation referred to above where applicable: n Gewaarmerkte afskrif van die student se identiteitsdokument as bewys van Suid-Afrikaanse burgerskap; Bewys van akademiese uitslae in huidige jaar en voorafgaande twee akademiese jare; A certified copy of the applicant s identity document as proof of South African citizenship; Proof of academic results in current year and two preceding academic years; Staaf asb. inkomste van die ouer/voog/uself/gade en heg aan die nuutste Please support income of the parent/guardian/yourself/spouse with, and attach, salaries- of pensioenstrokies of geouditeerde finansiële state van die betrokkene; latest salary- or pension slips or audited financial statements of the person concerned; In geval van werkloosheid n beëdigde verklaring van oorlewingsgeld; In case of unemployment, a sworn affidavit to declare survival money; Waar grootouers as voogde optree, n afskrif van die doodsertifikaat van ouer(s); If the grandparents act as guardians, a certified copy of death certificate of parent(s); Bewys van inkomste verkry van deeltydse werk of kontrakwerk; Proof of income from part time or contract work; KITEIA VI DIE TOEKENNING VAN DIE BEUS CITEIA FO THE ALLOCATION OF THE BUSAY Die volgende kriteria, in geen orde van voorkeur en in die uitsluitlike diskresie van die Fonds, sal oorweeg word in die toekenning van beurse: The following criteria, in no order of preference and in the sole discretion of the Fund, will be considered in the allocation of bursaries: Finansiële behoeftigheid, hetsy befondsing benodig word vir die geheel of n gedeelte van studie behoeftes vir n akademiese jaar; Financial need, whether in respect of all or part of the study needs for an academic year; Akademiese meriete; Academic merits; Prestasies op die volgende gebiede: leierskap, sport, kultuur en gemeenskapsdiens; Kwaliteit en tegniese versorging van die aansoek - aansoeke wat nie volledig en korrek ingevul is nie of laat ontvang word, sal ge-ignoreer word. Achievements in the following sectors: leadership, sport, culture and community service; Quality and technical preparation of this application applications not completed in full and correctly and late applications shall be ignored.
6 AFDELING I VEKLAING DEU APPLIKANT & OUE/VOOG SECTION I DECLAATION BY APPLICANT & PAENT/GUADIAN Hiermee verklaar ek dat die inligting hierin verskaf waar en korrek is en deur my handtekening hieronder, aanvaar ek hiermee onvoorwaardelik en erken en kom ooreen dat die terme en voorwaardes bindend op my sal wees, van toepassing op enige beurs van tyd tot tyd aan my toegeken deur - SHEILA BAND EDUCATIONAL TUST, EGISTASIE NOMME - MT 13770/2003. I herewith declare that the information provided herein is true and correct and by my signature hereunder, hereby unconditionally accept and agree to and acknowledge to be bound by the terms and conditions applicable to any bursary allocated to me from time to time by - SHEILA BAND EDUCATIONAL TUST, EGISTATION NUMBE - MT 13770/2003. Handtekening van Applikant Datum Signature of Applicant Date Handtekening van Ouer/Voog Datum Signature of Parent/Guardian Date Handtekening van Getuie Datum Signature of Witness Date
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