application form for bursary - za bursaries · (tut ,vut, wits, uj and up) not previously held a...
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City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
APPLICATION FORM FOR BURSARY
Please complete the application form thoroughly using BLACK INK
Completed application forms to be emailed to [email protected]
Closing date for applications is 01 February 2019.
NOTES & INSTRUCTIONS
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Please read these notes carefully before completing the application form. Be sure to readevery section and that the information provided is accurate.
Use block letters to complete the application form. Give concise answers and where applicable mark with X. We welcome applications from persons with disabilities. Incomplete or late applications will not be considered. In line with Johannesburg Water’s bursary procedure, financial aid to students is provided
on the basis of academic merit and financial need. All race groups are welcome to apply.Note that preference will be given to females and persons with disabilities.
Attach certified copies as indicated in H ( page6)
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Applicants must satisfy the following minimum entry criteria before applying: South African citizen Studying or accepted to study at the following recognized tertiary institutions in Gauteng
(TUT ,VUT, Wits, UJ and UP) Not previously held a bursary award or other funding ( excluding NSFAS)
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Please select the course you are currently studying:
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
BEng Tech : CivilEngineering
BEng Tech : Electrical( Heavy Current)
B Com Finance / FinancialAccounting / ManagementAccounting
SECTION A – PERSONAL DETAILS
Surname
First Names
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Identity No.SA Citizenship Yes NoGender Male FemaleRace African Indian Coloured WhiteDo you have a disability Yes No
If yes, describe the nature of the disability:
Permanent home address in full
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Postal address
Contact telephone numbers
Home CellularParent/ Guardian
Other contacts
Email address
* *Attach certified copy of Identity document
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION B – EDUCTATIONName of secondary school attended
School Address
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Grade(Please tick) Currently in Grade 12 Completed Grade 12Dates attended5 Subjects(list them below) Percentage Achievement Levels5.1 English5.2 Mathematics5.3 Mathematics 35.4 Mathematics literacy5.5 Physical science5.65.7
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
5.85.9
* Attach official statement of Results
SECTION C – POST- MATRIC STUDIES - Full Time Year of Study Year 1 Year 2 Year 3 Year 4
Institution Enrolled/Intend Enrolling
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Field of studyHave you been admitted for proposed studies Yes NoHave you already been admitted at Residence Yes No
If studies are discontinued, Give reasons
*Attach your full academic record to date (The application will not be considered if there is no attachment)
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION– D PARENT (S) / GUARDIAN (S) or OTHER , specifyFatherOccupationEmployerTelephone no Cell NoAnnual salary (attach copy of salary advice)
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
MotherOccupationEmployerTelephone no Cell NoAnnual salary (attach copy of salary advice)
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Other Occupation
Employer
Telephone no Cell NoAnnual salary (attach copy of salary advice)
* *Attach certified copies of Identity documents and an Affidavit if Parent(s)/ Guardian (s) are unemployed.
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION – F MOTIVATION
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Briefly answer the following questions in your own words: (you are free to attach a written addendum)
Why you have chosen this degree/diploma and how do you intend to use it after graduation
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
Tell us about your further study plans and ideals for the future?
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
What contribution do you feel you would be able to make to Johannesburg Water?
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION G- ACHIEVEMENTS
1. Give details of any activity (academic or otherwise) in which you have done well either at school and or university and have maybe achieved awards in:
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
2. Give details of your sporting activities:
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION H- DOCUMENTATION
Please attach certified copies of the following: Certified Identity document Official statement of Results Full academic record to date Certified copies of Identity documents of parents(s) or guardian(s) Copies of parent(s)/ guardian(s) salary advice or an Affidavit if they are unemployed Proof of registration/ admission from the institution
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
SECTION I- DECLARATIONIf this application is successful, I shall accept that the bursary will be subject to the relevant Terms and Conditions contained in the Johannesburg Water Bursary Scheme policy.
Sig Signed ……………………………………………………………Date…………………………………………...
City of JohannesburgJohannesburg Water SOC Ltd
17 Harrison StreetJohannesburg
Johannesburg WaterPO Box 61542Marshalltown2107
www.johannesburgwater.co.za
Tel +27(0) 11 688 1400Fax +27(0) 11 688 1528
Directors:
Ms Getty Simelane (Chairperson), Mr Ntshavheni Mukwevho (Managing Director), Adv John Mateya,
Ms Khanyisa Mdutshane, Mr Maselaganye Matji, Mr Brandon Furstenburg, Ms Azwiedziswi Tshivhunge, Professor Bheki Twala
Mr Sipho Sibiya (Company Secretary),
Johannesburg Water SOC Ltd
Registration Number: 2000/029271/30
S I d I declare that to the best of my knowledge all the information on this form is true and correct