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Application-Form-2021 Flipbook PDF
Application-Form-2021
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BURSARY APPLICATION
2021
Please read every section of the application form and complete in full the all required sections. Application forms without requested supporting documents will not be processed by Bhelesi Foundation. Bhelesi Foundation requires that you provide a cell phone number or an email address so that Bhelesi Foundation can communicate with you during the application process, and to inform you of the outcome of your application. If your application is successful, we need the cell phone number provided in the case that you qualify for allowances. If you are a student with a disability, you will be required to provide a medical certificate in support of your disability condition. Please contact BHELESI FOUNDATION on [email protected] for assistance Application for bursary funding is strictly for South African undergraduate students in the following fields of study: - Medicine (MBCHB) - Optometry - Dentistry - Agricultural Sciences - Animal Husbandry Please return the completed form with supporting documents to: [email protected] or post to Postnet Suite 128 Private Bag X10 Musgrave Durban 4062 Subject: Online Application/2021 BHELESI FOUNDATION
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PLEASE READ THROUGH CAREFULLY BEFORE COMPLETING THIS FORM 1
Please note that even if you may be eligible for the BHELESI FOUNDATION bursary funding, we advise you to also apply for other bursaries / student loans, as your application to BHELESI FOUNDATION does not guarantee acceptance.
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BHELESI FOUNDATION will not consider you for financial assistance unless you meet the requirements and criteria for funding, details of which can be found on our website: www.bhelesifoundation.org.za
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Information and documentation required in support of this application will ONLY be used for the purpose of assessing the financial eligibility of prospective students.
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The information may be shared with third parties including credit bureaus and other agencies for the purposes of information validation, criminal checks and to verify previous academic records.
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You are required to provide consent for BHELESI FOUNDATION to use the personal information you provide.
6.
Application closing date is 30 November 2020
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INSTRUCTIONS & CRITERIA 1
Please ensure that this form is completed in full.
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Complete in BLOCK LETTERS and BLACK INK.
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Note that a BHELESI FOUNDATION bursary cannot be used to pay for existing loans or student debt.
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Ensure that this form is duly signed.
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Incomplete or late applications will not be accepted.
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Applications are only open to South African citizens.
REQUIRED DOCUMENTS 1
Certified copy of a valid South African Identity Document / Card.
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Certified copy of an unabridged birth certificate (If you do not have a green bar- coded ID or smart ID card).
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Certified copy of ID of each household member including parents or legal guardian.
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Certified copy of a valid Senior Certificate (If you have completed Grade 12).
5
Certified copy of the latest academic results or record on official letterheads (if you are already at a university ).
6.
If you intend to register at any university for a degree in 2021, and you are not a student at any tertiary institution, you must submit a midyear academic transcript or school exam results.
7.
A copy of your proof of residence (see the checklist at the end for more information and examples of suitable documents).
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SECTION 2: APPLICATION FORM Please provide full names and ID number as per ID document. The stamp on your certified ID copy should not be older than 3 months and must be on the same side as the image of the ID.
PART A DETAILS OF APPLICANT Title
Mr
Surname
Full Names (as Per ID ) Muziwakhe Nzuzo
Dlamini
Identity Number Nationality
0 2 0 4 0 2 5 6 0 1 0 8 7
South African
Postal Address
Bhekumthetho Area
Postal Code
3 9 5 0
Postal Code
3 9 5 0
PO BOX 918 Nongoma Residential Address Bhekumthetho
Area
PO BOX 918 Nongoma Telephone No. Cellphone No.
0 6 6 0 9 3 8 2 9 5
Email Address
[email protected]
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Are you recieving any other form of financial assistance for your current studies?
Yes Loan
Type
No Bursary
R
Amount
Do you have any disability? (If yes please attach supporting documents)
Yes
No
Email
SMS
Do you recieve a SASSA grant?
Yes
No
Has there ever been an administration order issued against you?
Yes
No
How do you prefer Bhelesi Foundation contact you?
African
Race
Asian
Coloured
Indian
Have you ever been declared mentally unfit by a court of law?
White
Yes
No
PART B DETAILS OF YOUR CURRENT/MOST RECENT STUDIES Please provide a copy of your latest/most recent academic result as proof What are you doing this year? In School
Employed
Unemployed
Studying & Unemployed
Studying & Employed
Highest Academic Level Achieved Gr 9-11
Gr 12
1st - 5th Year
Final Year
Post Grad
Other Name of last School, College or University Attended KwaZiphethe
Secondary School
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PART C DETAILS OF YOUR PLANNED STUDIES Planned qualifications (Please list 5 choices for University qualifications to study in 2021)
1st Choice:
MBChB
Faculty :
Health Sciences
Level/Year of Study
1st
2nd
3rd
4th
1st
2nd
3rd
4th
1st
2nd
3rd
4th
1st
2nd
3rd
4th
1st
2nd
3rd
4th
2nd Choice:
Faculty : Level/Year of Study 3rd Choice:
Faculty :
Level/Year of Study 4th Choice:
Faculty :
Level/Year of Study 5th Choice:
Faculty :
Level/Year of Study
Bursary applications will only be considered for the following undergraduate fields of study: Medicine (MBChB) Optometry Dentistry Agricultural Sciences Animal Husbandry
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PART D DETAILS OF YOUR FAMILY You need to provide details of all the family members living with you. Certified copies of all their ID documents must be attached to your application. Please note: If you are married or have financially supported yourself for more than three years, or if both your parents are deceased and you have no legal guardian, then you are considered an independent applicant and you do not need to provide details of your parents. You will need to provide details of any of the family members living with you and dependent on the income that your family receives. Are either of your parents deceased? If you answer yes, you must use the section below to complete details of your next of kin or guardian:
Yes
Mother
No
Yes
Father
No
How many people are there in your family (including you)?
1-4 People
5 People
6 People
7 People
8 People
9+
Name of Mother/Stepmother/Legal guardian Identity Number
What does your Mother/Stepmother/Legal guardian do for a living?
Source of income
Employed
Not Employed
Studying
Other
Salary
Pension
Maintenance payments
Self Employed
Child Support Business Profit
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Annual income amount from these sources (before deductions and tax) Preferred means of contact (please provide at least 1): Email
Cellphone
0728492152
Name of Father/Stepfather/Legal guardian University Planned Qualification (Full Name)
University of Kwazulu Natal
Faculty :
Health Sciences
Identity Number
What does your Father/Stepfather/Legal guardian do for a living?
Source of income
Employed
Not Employed
Studying
Other
Salary
Pension
Self Employed
Child Support
Maintenance payments
Business Profit
Annual income amount from these sources (before deductions and tax) Preferred means of contact (please provide at least 1): Email
Cellphone
Name of Next of Kin (your closest living relative over the age of 18 years)
Identity Number Preferred means of contact (please provide at least 1): Email
Cellphone
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Please complete the table below for the remaining members of your family. Parents, legal guardian or next of kin details do not need to be included here: Names of other members in your family
What are they doing at the moment
ID Number
Relationship to you
School Employed Not Employed Studying School Employed Not Employed Studying School Employed Not Employed Studying School Employed Not Employed Studying School Employed Not Employed Studying
Financial support needed for 2021: R______________________________ What type of accommodation will you use next year while studying? If you are not staying at home, will you need financial assistance for meals? (For those not receiving meals allowance from the university)
Yes
No
Do you need financial assistance for travel to and from university / college?
Yes
No
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By signing this application form, I accept and understand that this application does not guarantee that I will receive a BHELESI FOUNDATION bursary. If I am not successful, I will be responsible for all required fees at the university. I understand that any false information provided as part of my application can disqualify me from receiving financial aid and will result in the immediate withdrawal of any approved bursary. I understand that if my application for financial aid is approved, the bursary agreement must be signed within 30 days after registration or BHELESI FOUNDATION reserves the right to withdraw the approved bursary. I will then be personally liable for all fees at the university. Signature of applicant __________________________ I give BHELESI FOUNDATION permission to validate the information I have provided with relevant third parties.
Date __________________________ Yes
No
BHELESI FOUNDATION requires personal information from SARS relating to the employment status and level of income of the parents or guardians of the applicant. BHELESI FOUNDATION is committed to ensuring that the personal information obtained from SARS is treated confidentially and also to protecting the privacy of the persons whose personal information is obtained from SARS. BHELESI FOUNDATION is further committed to protecting the personal information and to use that personal information in a lawful and transparent manner. The personal information obtained from SARS will only be used:- to assess and process the applicant’s application and to ensure that the applicant receives the appropriate level of financial support from BHELESI FOUNDATION to confirm and verify the identity of the parents or guardians of the applicant; in connection with legal proceedings; for audit and record keeping purposes; and for debt tracing and/or debt recovery purposes Signature of applicant __________________________ I hereby give consent under section 69(6)(b) of the Tax Administration Act, 2011, that my / our taxpayer information in the records of the South African Revenue Service may be disclosed to BHELESI FOUNDATION to the extent that it relates to my / our employment status and my / our levels of income.
Date __________________________
Yes
No
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In order for your application to be processed, please ensure that you complete all sections of the application form and attach all supporting documents. You must write your identity number on every page of all of your supporting documents in order for your application to be processed. BHELESI FOUNDATION will not process applications without an ID number.
Please attach certified copies of the following documents: - All the certified copies must not be older than 3 months. - Documents can be certified at the South African Police Service or the South African Post Office. - If you are under the age of 18 years or if you are 18 years and older and are still dependent on the household income of your parent(s) or legal guardian, then this also applies to you.
Please tick if included Yes
No
Certified copy of your Identity Document. If you are younger than 16 years of age, and do not have a green bar-coded ID or smart ID card, you must submit a certified copy of your unabridged birth certificate
Yes
No
Certified copy of Identity Document of each household member including parents or legal guardian.
Yes
No
Yes
No
Yes
No
Certified or official copy of recent pay slip, letter of employment, not older than three months, for each parent, or the person who supports you financially, or your guardian or yourself, if you are employed. This is for all types of employment or all forms of income for all members of the household. This includes any income received from SASSA grants, Unemployment Insurance Fund (UIF), or any retirement, life, disability or other benefits paid as a lump sum or in monthly payments.
Yes
No
If your parent(s) or the person who supports you financially or your legal guardian is retired, please provide a copy of an official pension slip or bank statement showing pension payment.
Yes
No
If your parent(s) or the person who supports you financially or your legal guardian work as an informal trader, please provide an affidavit signed by them to confirm this employment.
Yes
No
If either of your parents is deceased, please provide a copy of the death certificate
Yes
No
If your parents are divorced, please provide a copy of the divorce decree.
Yes
No
If either of your parents does not live at home, please provide an affidavit explaining the reasons.
Yes
No
Yes
No
Certified copy of a SASSA letter if any of your family members are receiving a social grant and are also contributing to your household income. This also applies to legal guardian
Yes
No
If you have indicated that a dependent in your household is a student, please provide proof of registration of acceptance at the TVET college or university for each dependent.
Yes
No
If you have a disability, please provide evidence (a letter from your Doctor / Clinic / Hospital).
Yes
No
Certified copy of your latest academic transcript or exam results. If you re currently in Grade 12, you do not need to submit this. If you’ve been exempted from paying school fees, please provide a letter from the school informing BHELESI FOUNDATION that you have been duly exempted.
If you are financially supported by someone who is not your parent or legal guardian, please provide an affidavit explaining the relationship and amount received per month.
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[email protected]
www.bhelesifoundation.org.za
Postnet Suite 128 Private Bag X10 Musgrave Durban 4062