RICHARDS BAY COAL TERMINAL PROPRIETARY LIMITED

COMMUNITY BURSARY FUND

APPLICATION FORM

FOR

TERTIARY EDUCATION FULLTIME STUDIES AT UNIVERSITY

NB: APPLICANTS WHO RESIDE WITHIN THE UTHUNGULU DISTRICT MUNICIPALITY AREAS WILL BE GIVEN FIRST
PREFERENCE

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 Only applications in respect of the following disciplines will be considered for 2020.
Please mark your choice with a tick in the appropriate block below

Discipline Tick √

B Sc. Mechanical Engineering

B Sc. Electrical Engineering

ND Mechanical Engineering

ND Electrical Engineering

B Sc. Computer Science/I.T.

Closing date: 30th August 2019

Applicants who do not receive communication from the Bursary Administrator on or

before 31 October 2019 must please accept that their applications were unsuccessful

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Rules and instructions

Please read these notes carefully before you complete the application form.

Make sure that you read every section and that the information you provide is accurate.

1. Applicants who reside within the King Cetshwayo District Municipality areas will be given first preference
2. This form is to be completed by the applicant applying for the bursary
3. Please furnish all the requested information. Incomplete application forms will not be considered.
4. An applicant who is found to have submitted false information will be automatically disqualified from being
considered for the bursary.
5. Applications received after the closing date will not be considered
6. Failure to submit all required supporting documents will result in the application being disqualified
7. Financial need of each applicant will be taken into consideration when assessing the applications
8. Shortlisted applicants will be notified and asked to participate in an assessment programme.
9. Documentary proof (certified copies of school/tertiary reports, academic results, certificates, etc) in respect
of all academic results and achievements stated in application form must be submitted with the application
form. Failure to do so will result in the application being disqualified.
10. Please do not send original documents. Attach certified copies of documents to the application form.
11. Completed application forms must be emailed to Saloshini Pillay at spillay@rbct.co.za before the closing
date.

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1. Personal details of applicant

Surname

Full names :

Race (for stats purposes only)

Gender

ID Number

Place of birth

Cell phone

e-mail address

Do you reside within the King Cetshwayo District Municipality area? Yes or No

Please encircle response

Postal Address (home) Residential address

…………………………………………………………………………… ……………………………………………………………………………

………………………………………………………………………….. …………………………………………………………………………..

………………………………………………………………………….. …………………………………………………………………………..

…………………………………………………………………………. ………………………………………………………………………….

2. Parent/ Guardian Details.

Surname
Full names
Relationship to applicant
Postal address (home) Residential address
……………………………………………………………………….. ………………………………………………………………………..

……………………………………………………………………….. ………………………………………………………………………..

……………………………………………………………………….. ………………………………………………………………………..

………………………………………………………………………... ………………………………………………………………………..

Telephone (home)……………………………………………..
Fathers Mothers
Cell phone: ………………………………………………………. Cell phone: ……………………………………………………..

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Parent/ Guardian Details Cont.

Fathers Occupation: .............................................. Mothers Occupation: ...............................................

Work address (physical) Work address (physical)
…………………………………………………………………….. ……………………………………………………………………..
…………………………………………………………………….. ……………………………………………………………………..
……………………………………………………………………. ……………………………………………………………………..
…………………………………………………………………….. ……………………………………………………………………..
Work address (postal) Work address (postal)
…………………………………………………………………….. ……………………………………………………………………..
…………………………………………………………………….. ……………………………………………………………………..
……………………………………………………………………. ……………………………………………………………………..
…………………………………………………………………….. ……………………………………………………………………..

Telephone (work)……………………………………….. Telephone (work)………………………………………..

Father Salary/Income per month: ........................... Mother Salary/Income per month: .........................

Number of dependents: .........................................

3. Details of current/last learning institution attended

Name of Institution

High School: ………………………………...........................................

Tertiary: ..................................................................................
Write the name of the studies you want to follow at the university or the current course of study
(qualification) you are doing at the university in the dotted line below and tick the current level of
study :
..........................................................................................................................................................
Name of University:
Please encircle the year of study
a. 1st year
b. 2nd year
c. 3rd year
d. 4th year

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4. Bursary Information.
Please note that bursaries will only be awarded for FULLTIME study at the University

What career do you wish to follow?

………………………………………………………………………………………………………………

State the academic year / level of study for which you are applying for a bursary for next year.
……………………………………………………………………………………………………………

Duration of study period for the Diploma/Degree for which you are applying for a bursary?
__________Years______Months

Do you have a bursary at Yes No If yes, from whom:

present?
Have you had a school or Yes
tertiary bursary in the past?
Do any of your brothers or Yes
sisters have a bursary?
Have you ever failed a year / Yes
semester of study?
Have you previously
interrupted your studies
Have you ever changed your Yes
direction/field of study?
Do you, or have you ever held
any position of leadership or
have you been awarded for
special achievements?
NB: Attach certified copies of
certificates.
Value of the bursary R………………………..
No If yes, from whom:
Value of bursary R…………………………….
No If yes, from whom:
Value of bursary R…………………………..
No If yes, please give details:
................……………………………………………..
Yes No If yes, why did you interrupt your studies?
………………………………………………………………………………………
……………………………….....................................................
No If yes, please give details
…………………………………………………………..........................
Yes No If yes, please give details
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………

5. Motivation by applicant
Please briefly state why you have chosen this field of study – What have you done to find out more about this
type of a career? Please indicate the reasons for your application:

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6. Required certified copies
1) Applicant ID copy
2) Parents/guardian certified ID copies
3) Parents/guardian copy proof of Income/Salary Slips (Father and Mother)
4) Applicant Grade11 final year results/reports (scholars)
5) Applicant Grade 12 mid-year results/reports (scholars)
6) Applicant Grade 12 final results/reports (school leavers and university students)
7) Proof of registration/application at a Tertiary Institution (if available)
8) Applicant latest statement of academic results/reports (university students)
9) Shortened Curriculum Vitae (max 1 page including contact details)

I hereby acknowledge that the information provided in my application form is true and correct and I
confirm that I understand the rules and instructions stipulated in this application form.

Signature of applicant: Date:

Signature of parent/guardian: Date:

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