ApplicationForm Solomon Mahlangu 2015
Solomon Mahlangu Scholarship Fund (SMSF) Application Form 2015 For study at University and University of Technology 1 SOLOMON MAHLANGU SCHOLARSHIP FUND 2015 CLOSING DATE: 23 JANUARY 2015 • APPLICANTS INTENDING TO APPLY AT A UNIVERSITY CAN APPLY FOR ONLY THE PARTICIPATING UNIVERSITIES LISTED ON THE ADVERT AND • APPLICANTS MUST: - MEET UNIVERSITY ADMISSION POINT SCORE (APS) AND ACHIEVE AN AVERAGE OF 70% IN THE NSC EXAMS - BE APPLYING AS A 1ST YEAR FULL TIME STUDENT IN THE FIELDS OF STUDY LISTED IN THE ADVERT - BE A SOUTH AFRICAN CITIZENS BETWEEN AGES OF 14-35 - FINANCIAL NEEDY- COMBINED HOUSEHOLD SALARY OF LESS THAN R15 000.00 A MONTH - DEMONSTRATE LEADERSHIP QUALITIES BY PARTICIPATING IN COMMUNITY SERVICE (MOTIVATION REQUIRED) - COMMIT TO DO 20DAYS OF COMMUNITY SERVICE DURING THEIR STUDIES SUBMIT THEIR APPLICATION DIRECTLY TO THAT UNIVERSITY Please note: • NO LATE OR INCOMPLETE APPLICATIONS WILL BE ACCEPTED • ALL INFORMATION SUBMITTED IS STRICTLY CONFIDENTIAL • ONLY SHORTLISTED STUDENTS WILL BE CONTACTED FOR OFFICE USE ONLY HAS THE APPLICANT ATTACHED ALL THE REQUIRED DOCUMENTS? IS THE CHOSEN FIELD OF STUDY RELEVANT RECOMMENDED (IF) NOT RECOMMENDED GIVE BRIEF REASON(S) YES NO YES NO YES NO DATE STAMP RECEIVED BY……………………………………………………… 2 1. DETAILS OF THE UNIVERSITY/ UNIVERSITY OF TECHNOLOGY 1.1 Name of University/ University of Technology 1.2 Name of Qualification (e.g. Bsc, BAcc, Diploma in I.T) 1.3 Field of Study (e.g. Engineering, Law, Tourism, Pharmacy) 1.4 Level of study (Year 1,2 or Semester 1, 2) 1.5 Did you apply for residence? (√) YES NO 2. YOUR PERSONAL DETAILS Attach certified ID copy 2.1 Name 2.2 Surname 2.3 ID Number 2.4 Do you have any other form of funding? YES NO If YES, state the sponsor and the amount: 2.5 Are you currently employed? YES NO If YES, state the employer and your occupation: 2.6 Contact details Home Telephone Number E-mail 2.7 Physical address (Please attach proof of Residence) 3. Cellphone Number Facebook Profile Alternative Cellphone Number Preferred Method of Contact 2.8 Postal address (If different from physical) HIGH SCHOOL RESULTS Attached certified copy of matric results OR latest Grade 12 results 3.1 Name of last school attended 3.2 Matric results SUBJECT MARK 3 4. PARENT’S/ GUARDIAN’S EMPLOYMENT DETAILS • • Attach a certified ID copies, payslips, 3 month bank statement. Attach an affidavit if unemployed or self-employed Father Mother Guardian 4.1 Name and Surname 4.2 ID Number 4.3 Telephone number/ Mobile 4.4 Residential Address 4.5 Employer 4.6 Monthly Income 4.6 Employer’s telephone number COMMUNITY INVOLVEMENT (Briefly explain how you have contributed to your community) Attach reference 2 reference letters 5. Sector What did you do? • Health • Environment • Religious • Social • Other (Explain) When did participate in this activity? Reference (Name and Contact) 4 MOTIVATION Motivate why you should be awarded the Solomon Mahlangu Scholarship 6. Declaration by the applicant I _____________________________________________________________________ ID number: ____________________________________________________declare that all the above information is factually correct. Signature: ______________________________________ Date : _____________________________ PLEASE ENSURE THAT ALL THE SECTIONS OF THE APPLICATION FORM ARE COMPLETED APPLICATION CHECK LIST FOR SUPPORING DOCUMENTS Please ensure that you have attached the following supporting documents: Proof of residence Certified copy of matric certificate or statement of results Certified copy of IDs Certified copy of parent’s/ guardian’s payslip, ID and bank statement Reference letters (X2) 5 FIELDS OF STUDY • • • • • • • • • • • Engineering Tourism ICT Agriculture Law Logistics Supply Chain Management Journalism Geology Pharmacy Development Studies UNIVERSITY CONTACT DETAILS Province Northern Cape University Sol Plaatjie University Mpumalanga Mpumalanga University Eastern Cape Fort Hare University Rhodes University Nelson Mandela Metro University Contact Moganisi Tshego Financial Aid Officer Sol Plaatje University North Campus, Chapel Street Kimberley; 8300 Tel: 053 807 5300 E-mail: [email protected] Joe Mokoatala /Joy Nkosi Head of Student Affairs Mpumalanga University Corner of R40 White River Road Riverside , Mbombela 1226 Tel: 013 753 3069 Email: [email protected] And [email protected] Mr Luxolo Rangile Senior Financial Aid Officer: Finance Department University of Fort Hare 50 Church Street East London 1st Floor, Block “D” Main Building Tel: 043 704 7108 E-mail: [email protected] Mr Luyanda Bheyile Manager: Undergraduate Student Funding Rhodes University Eden Grove Building Grahamstown 6140 Tel: 046 603 8248 E-mail: [email protected] Ranchia Arends Financial Aid Officer Nelson Mandela Metropolitan University Financial Aid Office PO BOX 77000 6 Port Elizabeth 6031 Tel: 041 5042514 E-Mail: [email protected] Ms Namhla Krele Students Affairs Walter Sisulu University Private Bag X1 UNITRA 5117 Tel: 047 502 2428 Email: [email protected] Ms Bogadi Sito Motsamaisi Dithuso tsa Matlole Lefapha la Matlole Setlogelo Drive Mahikeng 2790 Tel: 018-389-2546 E-mail: [email protected] Ms Makhosi Ndelu Financial Aid Advisor College of Humanities Howard College University of KwaZulu-Natal Mazisi Kunene Road, Glenwood Durban Tel: 031-2602110 E-mail: [email protected] Ms Rozenthel Davids Officer : Financial Aid Student Academic Services PO Box / Posbus 339, Bloemfontein 9300 Tel: 051 401 3603 E-mail: [email protected] Walter Sisulu University North West University of North West KwaZulu Natal University of Kwa Zulu Natal Free State University of the Free State Gauteng Tshwane Technology University University of JHB of Mr Thapelo "Eddie" Ntho Senior Financial Aid Advisor Pretoria Campus Tshwane University of Technology Private Bag X680 Pretoria 0001 Staatsartillerie Road Pretoria West Tel: 012 382 4289 Email: [email protected] Ms Rhona Kruger Financial Officer: External Bursaries Auckland Park Campus APK University Of Johannesburg PO Box 524 Auckland Park 2006 Tel: 011559-4787 E-mail: [email protected] 7 Wits University University of Pretoria Limpopo University of Limpopo Western Cape Cape Peninsula University of Technology Stellenbosch University University of Western Cape University of Cape Town Ms Jabulile Ramorola Financial Aid and Scholarships Office 1 Jan Smuts Avenue Braamfontein 2000 Johannesburg Tel: 011 717 1081 E-mail: [email protected] Mr Zakhele Nkosi University Relations: Advancement Marketing Services Building University of Pretoria University Rd / Lynnwood Rd Pretoria 0002 Room 1-6 Tel: 012 420 5528 E-mail: [email protected] Ms Mapula Ramethape Director: Financial Aid Private Bag X1106 Sovenga 0727 Tel: 015 268 3542 E-mail: [email protected] Ms Khumo Sebola Department of Advancement Cape Peninsula University of Technology Cape Town Campus Symphony Way Bellville South Industrial Cape Town 7530 Tel: 021 460 3387 E-mail: [email protected] Mr Khaya Jack University of Stellenbosch Development Officer Institutional Advancement Stellenbosch Central Stellenbosch 7600 Tel: +27 21 808-9262 E-mail: [email protected] Ms Rhona Erasmus Corporate Bursaries Financial Aid Robert Sobukwe Rd Bellville Cape Town 7535 Tel: 021 959-3059 E-mail: [email protected] Mr Zair Baker Student Financial Aid Office Level 3, Kramer Law Building Cross Campus Road, Middle Campus 8 Rondebosch Private Bag X3 Rondebosch; 7701 E-mail: [email protected] 9
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