BURSARY APPLICATION

Application forms will not be accepted

through fax or email.
Please post forms or deliver by hand.
Application forms are available from 1 July each year
and may be collected or posted on request.
Tel: 021 685 1025

FOR OFFICE USE ONLY RETURN APPLICATION FORM TO:

5 Long Street, Mowbray, 7700,
W. Cape, South Africa

RETURN BY
30th SEPTEMBER
(the year before you start your studies)

 IMPORTANT INFORMATION

ELIGIBILITY
 Only South African citizens who are resident in the Western Cape are eligible.
 Students who are in Grade 12 going to study for a first degree, diploma or higher certificate.
APPLICATIONS
 Applications may be made for a University OR University of Technology in the Western Cape only.
Applications for private institutions or FET Colleges are not accepted.
 In view of large numbers of applications, only successful candidates will be notified. This will be
done by the end of February.
AWARDS
 Awards are made by a Selection Committee meeting in late January and are based on merit and
financial need. Where funds are limited priority is given to students who are financially needy and
who are from less advantaged communities.
 Awards are variable and cover a percentage of the cost of tuition and books.
 ASSET bursaries are not repayable.
 Bursary funds are paid directly to tertiary institutions.

 IMPORTANT DOCUMENTS TO INCLUDE WITH YOUR APPLICATION

Please send certified copies of documents 1, 2 and 3.
Check
1. Identity Document (ID) 
2. Final School Certificate (if available – new applicants only) 
3. Latest results from school or tertiary institution (if finals not available) 
4. Documentary evidence from all income earners in your home (see Section B) 

 You should submit a certified copy of final results as soon as they are available.
 Please print clearly and check that you have completed the following application form
(4 pages) in full.
 ASSET BURSARY APPLICATION FORM Page 1 0f 4
Application Number: Office Use only

SECTION A: PERSONAL INFORMATION

TO BE COMPLETED BY ALL APPLICANTS Place of Birth

Title Date of Birth Day Month Year

Mr Mrs Ms

ID Number
Surname

Telephone/Home contact
First Names (in full)

Cell phone

Postal Address (if different from home address)

Home Address

Code
Code

E-mail address:

SECTION B: FAMILY DETAILS

TO BE COMPLETED BY ALL APPLICANTS
Write on the back of this page if you need to give any other details not covered in this section.
How many people live in your house, including yourself?
No. of learners in family still at school (Grade R – Grade 12), including yourself
No. of students in family studying at University or other Tertiary Institution, including
yourself
Name of Parent(s) or Name of Guardian

FAMILY INCOME -Confidential

List below all the people in your family/household who receive an income.
Surname Initials Approx Relationship to you e.g. Occupation Monthly
Age Mother, Sister, (including self Income
Uncle/Guardian employment)

N.B. Send copies only, (not originals) of pay slips, or pension advice. If any working person does not
get a pay slip, they should get a sworn statement (an affidavit) from the nearest police station stating
how much that person earns.
 ASSET BURSARY APPLICATION FORM Page 2 0f 4

SECTION C: SCHOOL DETAILS

TO BE COMPLETED BY APPLICANTS WHO ARE WRITING SENIOR CERTIFICATE THIS YEAR AND THOSE
WHO HAVE PREVIOUSLY WRITTEN BUT HAVE NOT YET ATTENDED A TERTIARY INSTITUTION

1. Name of school ________________________________________________________

2. Are you writing your Senior Certificate this year? (Yes/No) ______________________

3. If ‘No’, what year did you write your Senior Certificate? _________________________

4. If you wrote before this year, are you upgrading your marks? (Yes/No)_______________

SECTION D: PLANS FOR TERTIARY STUDIES NEXT YEAR

NB: Applications for Private Institutions are not accepted

TO BE COMPLETED BY NEW APPLICANTS ONLY

1. Name of institution where you intend studying _________________________________

2. Have you applied to this institution (Yes/No)? __________________________________

a. Have you applied to any other institution(s) (Yes/No)? __________________________

b. If yes which one(s)? ___________________________________________________

3. What Degree/Diploma/Certificate Course do you intend studying? (Write out in full

e.g. BSc Engineering, ND Information Technology, NHC Accounting)

st
1 Choice ________________________________________________________

2nd Choice ________________________________________________________

4. Length of Course? (Circle the No. of years)

1 2 3 4 5 6

5. Why have you chosen this Degree/Diploma/Certificate Course and what do you intend doing
when you have completed it?
___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________
 ASSET BURSARY APPLICATION FORM Page 3 0f 4

SECTION E: APPLICATION FOR BURSARY RENEWAL

TO BE COMPLETED BY CURRENT BURSARS APPLYING FOR A BURSARY RENEWAL

1. Name of Institution _____________________________________________________

2. Course for which you are currently registered (Write out in full
e.g. BSc Engineering, ND Information Technology, NHC Accounting)
_____________________________________________________________________

3. Student number

4. Year of study (Circle year currently registered)

1 2 3 4 5 6

5. Enter your most recent exam results below:

Month Year Subject % or symbol

6. Course for which you are registering next year (Write out in full
e.g. BSc Engineering, ND Information Technology, NHC Accounting)
______________________________________________________________________

Additional Bursaries/Loans

1. Were you awarded any other bursaries, loans or scholarships in the present year or last year?

(Yes/No) ____________________

If yes, complete the following:

Year By whom granted Value Loan or Bursary

 ASSET BURSARY APPLICATION FORM Page 4 0f 4

SECTION F: MOTIVATION
TO BE COMPLETED BY ALL APPLICANTS

Motivate your application by writing something about yourself, and your goals in life.
If you are applying for a bursary renewal, write about the course you are studying and your
experiences as a student so far.
___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

SECTION G: CONTACTABLE REFERENCE

TO BE COMPLETED BY ALL APPLICANTS

Give details of one person (except your School Principal) who knows you well and can be contacted for a reference.

Name and title (Mr. / Mrs. / Ms.) ___________________________________________________

Occupation: ___________________________________________________________________

Address Telephone

Cell phone

Code

SECTION H: DECLARATION
TO BE COMPLETED BY ALL APPLICANTS

I hereby declare that the information given in this application is correct. I understand that if the
information is found to be incorrect and does not comply with the conditions of ASSET, the support
may be discontinued with immediate effect and legal action may be instituted.

Signature of applicant: _________________________________________________________

Assisted by Parent/Guardian: _______________________________if applicant is under 18 years.

Signature of Parent/Guardian: ____________________________________________________

Date: _______________________________________________