P O Box 10813

Document Sample
P O Box 10813 Powered By Docstoc
					                                                                                                   1
                                                                              P O Box 10813
                                                                              LINTON GRANGE
                                                                              6015
                                                                             Tel: 0861 113 297
                                                                             Fax: 041 379 5388
                                                                           Email: admin@saslha.co.za



                    Myrtle L Aron Bursary Fund
                       Application Form
             CLOSING DATE FOR THE APPLICATION: 31 JANUARY, OF EVERY YEAR


         THE BURSARY IS AVAILABLE FOR STUDENTS WHO HAVE SUCCESSFULLY
         COMPLETED THEIR 1ST YEAR OF A SPEECH PATHOLOGY AND AUDIOLOGY DEGREE.

PERSONAL DETAILS
SURNAME: ___________________________________________________________
FIRST NAME: _________________________________________________________
GENDER: Male _____________ Female_________________
AGE: ________________________________________________________________
DATE OF BIRTH: ______________________________________________________
I.D NUMBER:________________________________________________________
NATIONALITY________________________________________________________
MARITAL STATUS: ___________________________________________________
No OF DEPENDENTS: _________________________________________________
PREVIOUSLY DISADVANTAGED GROUP: YES______________NO___________
DO YOU STAY: ON CAMPUS______________WITH PARENTS_______________
WITH OWN FAMILY_____________________OWN APARTMENT ___________
HOME ADDRESS: ________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
POSTAL ADDRESS: ___________________________________________________
_____________________________________________________________________
____________________________________________CODE____________________
TEL NO: (______) _________________________________
CELL.NO ________________________________________
Email ADDRESS: _____________________________________________________
BANKING DETAILS:
NAME OF ACCOUNT HOLDER__________________________________________
NAME OF BANK ______________________________________________________
BRANCH _____________________________________________________________
BRANCH CODE_______________________________________________________
ACCOUNT NUMBER __________________________________________________
UNIVERSITY DETAILS
UNIVERSITY_________________________________________________________
UNIVERSITY DEPT. TEL NO: (_________) ____________________
PRESENT YEAR OF STUDY: ____________________________________________
FIRST YEAR OF REGISTRATION AT UNIVERSITY__________________________
                                                                                     2
HOW DID YOU HEAR ABOUT THE Myrtle L Aron Bursary Fund ?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
ARE YOU A SASLHA STUDENT MEMBER? __________________________________

HAVE YOU APPLIED FOR ANY OTHER BURSARY, GRANT OR LOAN? YES / NO
IF SO STATE THE NAME OF THE ORGANISATION TO WHICH YOU HAVE
APPLIED: __________________________________________________________________
WHEN     DID    YOU     SUBMIT      YOUR     APPLICATION      TO    THEM?:
_______________________________________________________________________
AMOUNT APPLIED FOR: R____________________________
WAS YOUR APPLICATION SUCCESSFUL? YES / NO

Motivate why you believe that you deserve this award?

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________

Give a brief description of yourself, your hobbies and your community involvement.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________


Matriculation details:

School: __________________________________________________________________
Year of Matriculation: ______________________________________________________

Please enclose a certified copy of your matriculation certificate.

Post Matriculation details:
                                                                                3
Describe what you have done since matriculation. Include forms of occupation,
attendance at Universities, Colleges.

YEAR        NAME OF INSTITUTION                    COURSE   OF   STUDY     OR
                                                   OCCUPATION




Details of subjects studied and grades obtained:

FIRST YEAR: LAST SEMESTER
SUBJECTS                                              GRADES




SECOND YEAR: LAST SEMESTER
SUBJECTS                                              GRADES




THIRD YEAR: LAST SEMESTER
SUBJECTS                                              GRADES
                                                                                             4
FOURTH YEAR: LAST SEMESTER
SUBJECTS                                                  GRADES




Please enclose certified copies of the most recent certificate of your subjects and grades



Please enclose two testimonials:

   1. From any academic staff member of the department of Speech Pathology and
      Audiology/Communication Pathology
   2. From any other person or organization you belong to

I, __________________________________________________________________hereby
declare that all the above information is accurate. I understand that the Council’s decision
is final.

Signed on this __________day of________________________ 2______



_______________________________

Signature




                       PLEASE DO NOT FAX THIS FORM

MAIL COMPLETED FORMS TO:
    SASLHA
    PO BOX 10813
    LINTON GRANGE
    6015

				
DOCUMENT INFO
Shared By:
Tags: 10813
Stats:
views:18
posted:12/5/2009
language:English
pages:4
Description: P O Box 10813