YOUTH EMPOWERMENT ORGANISATION APPLICATION FOR STUDY FUND: 2018

Transcription

1 -1- YOUTH EMPOWERMENT ORGANISATION APPLICATION FOR STUDY FUND: 2018 PART 1 APPLICATION DETAILS STUDY FUND Student Number (If available) University intended to study (Attach proof of admission letter) Discipline/Qualification, e.g. BComm (Accounting) Main Subjects: Indicate the academic year of which you are applying Have you been granted a bursary fund before? If yes state of which degree/diploma Address PART 2 APPLICANT INFORMATION Surname: Full Names: Date of Birth: ID Number: Title: Gender: Male: Female: Race: African Coloured Indian White Nationality: Marital Status:

2 Home Language: Disability: Yes No: If Yes (Explain): -2- Contact Details: Cell: Home Tel: Alt No: Address: Residential Address: Postal Address: Have you written your final grade 12 Exam? Yes: No: Please attach your matric results for Grade 12-June 2017/ Grade 11 -Year End) Aggregate Symbol: PART 3 IF YOU ARE ALREADY AT TERTIARY LEVEL KINDLY ATTACH THE FOLLOWING: Latest Results; Academic Record; Outstanding Balance Statement; Do you currently have a Scholarship, Bursary or Loan? If yes indicate the following: What is the name of the award? Who has it been awarded by? What is the value of the award? PART 4: PARENTS/GUARDIAN INFORMATION Surname: Initials: First Names: Cell No: Tel No:

3 -3- Residential Address: Postal Address: PARENT /GUARDIAN EMPLOYMENT DETAILS Type of Employment: Permanen t Temporary Contract Self Employed Employer s Address: Phone: Fax No: Position: Annual Income: PREVIOUS EMPLOYER (S) Name: Occupation: Period of Employment NB: IF LIVING WITH BOTH PARENTS KINDLY FILL THE FORM BELOW

4 -4- PARENT /GUARDIAN EMPLOYMENT DETAILS Type of Employment: Permanen t Temporary Contract Self Employed Employer s Address: Phone: Fax No: Position: Annual Income: PREVIOUS EMPLOYER (S) Name: Occupation: Period of Employment HOUSEHOLD INFORMATION Do you live in the same household with your parent/guardian? Yes No Total number of people living with you: Number of Dependents: Dependents in School: Not in School: Total Number of household members earning income: Other source of household income:

5 -5- PART5: REFERENCE Name: Address: Phone: DECLARATION 1. I confirm that the information given in this form is accurate and truthful; 2. I understand that all information provided in my application may be followed -up and I authorize Youth Empowerment Organization to contact any relevant person or tuition for relevant references; 3. I authorize any school/university to provide Youth Employment Organization with the relevant information which may be useful in making a decision; Signature of applicants: Signature of parent/guardian: Date: Date: RECOMMENDATION: THE CLOSING DATE FOR SUBMISSION: 28 FEBRUARY 2018 Please attach the following documents: Grade 12 results or recent academic record Certified copy of ID Certified copy of parent/guardian ID document Letter/Proof of admission form the institute of higher learning Proof of parents/guardian income (of total monthly income not exceeding R3 500) Copy of pension slip ( for indigent applicants) Affidavit (if parent is unemployed) Proof of residence CLOSING DATE: 28 FEBRUARY completed form to info@youthempowermentsa.co.za

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