Bursary Application Form
Personal Information
Surname Title Mr Mrs Miss Other
Full Names Marital Status
Preferred Name Date of Birth D D M M Y Y Y Y
Place of Birth
Nationality Home Language
Your Home Address
Your Contact Telephone Number Your Contact Email Address
Full Names of Next of Kin/ Parents/ Legal Guardian
Contact Telephone Numbers of Next of Kin/ Parents/ Legal Guardian
Have you ever been convicted of a criminal offence? Yes No
If “Yes” please give particulars
State of Health
Differently abled Yes No Type of disability
Student Information
Mid-Term, Matriculation or Equivalent Qualification
Grade Obtained Year in which examination was written Y Y Y Y
School Town/ City Region
School Achievements
Grade 12 Evaluation Scale
Specify Subjects Evaluation Scale Symbol Obtained Percentage (%) Obtained
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Tertiary Education/ Current Studies Information
Please indicate your field of study
Institution
Year of study in 2026 1st 2nd 3rd 4th
What year did you commence your studies Y Y Y Y
Additional Information
Are you currently having or have your received another bursary or study loan? Yes No
If “Yes” please state
1. Name of Institution that granted bursary/ study loan
2. Obligation/ Conditions
Declaration
I, in my capacity as applicant/ Parent/ Guardian, declare that the above particulars are
complete and correct.
Signature of Applicant Date D D M M Y Y Y Y
Signature of Parent/ Guardian Date D D M M Y Y Y Y
(in case of a minor)
Important: Please attach the following documents:
Applicant’s Motivation
Comprehensive CV
Certified copies of testimonial
Certified copies of ID Card/Passport
Certified copies of Grade 11 or 12 Results (NQF Level 4)
A complete official study or annual records/percentages obtained in any examinations already written.
A copy of the relevant contract of any other funding for your education.
Important Notes
Please do not attach original academic records.
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