BURSARY APPLICATION FORM

BURSARY APPLICATION FORM

Please use a black pen

Please tick () to indicate your current status: ( ) Presently in Grade 12

( ) Matriculated but not yet at tertiary ( ) Currently at tertiary: ( ) University ( ) University of Technology

Male ( ) Female ( )

Surname: ___________________________________________________ Other names in full:

Please tick () the course you wish to study, or are studying. Indicate your first, second and third choices by writing 1, 2 or 3 in the appropriate spaces:

B COMM

( ) ACCOUNTING MAJOR (Affirmative only) ( ) INFORMATION SYSTEMS (Affirmative only) ( ) B COM (INFORMATION SYSTEMS)

BSC

( ) CHEMISTRY (Affirmative only)

( ) COMPUTER SCIENCE/SYSTEMS (Affirmative only) ( ) ACTUARIAL SCIENCE ENGINEERING ( ) MINING ( ) MECHANICAL ( ) METALLURGY ( ) CHEMICAL ( ) CIVIL ( ) INDUSTRIAL

( ) QUANTITY SURVEY (Affirmative only) ( ) ELECTRICAL ( ) HEAVY CURRENT ( ) ELECTRONIC ( ) GEOLOGY ( ) MINE SURVEY ( ) MEDICINE ( ) OTHER (Specify) ___________________________________

COMPANY PREFERENCE: Indicate order of preference 1,2,3 etc. ( ) ANGLO AMERICAN THERMAL COAL

( ) ASA METALS

( ) BHP BILLITON (Indicate Preference):

Energy Coal 

Samancor 

Northern Cape 

( ) COAL OF AFRICA ( ) DE BEERS

( ) DISCOVERY HEALTH (Actuarial Science Only)

( ) NATIONAL SKILLS FUND (All Disciplines Financial Need Criteria) ( ) PETRA DIAMONDS

( ) PPC ( ) VODACOM

( ) WITS GOLD (Females Only Living in a Mining Area)

TRUST SCHOLARSHIPS (Proof of financial need required)

( ) ERNEST OPPENHEIMER TRUST (All disciplines including Arts) ( ) GALLAGHER FOUNDATION (Science, Business, Medicine or Teaching degrees – studies at University of Cape Town) ( ) FNB FUND BURSARY PROGRAMME (Any BCom/ Engineering)

PLEASE RETURN THIS APPLICATION FORM TO THE ADDRESS BELOW: Career Wise (Pty) Ltd

PO Box 30632, Braamfontein, 2017 Fax: 086 602 8949 e-mail: [email protected]

Website:www.careerwise.co.za

Reference Number: 217006

PLEASE FILL IN YOUR NAME AND ADDRESS IN THE PANEL BELOW

To: __________________________________________ __________________________________________ __________________________________________ __________________________________________ Please glue a passport size photo here (Head & Shoulders)

Corporate Recruitment and Bursary Services Telephone (011) 484 7505

2

A. Personal Details

1 Currently studying at the following University / University of Technology

_________________________________________________________ 2 Name of the proposed university: (If not yet at University /

University of Technology)

_________________________________________________________ 3 Name and address of your present or last school:

_________________________________________________________ _________________________________________________________ _________________________________________________________ Postal Code: _____________________________________________ School telephone no: _________________ Dialing code: _______ Permanent Home address in full:

_________________________________________________________ _________________________________________________________ Postal Code: _____________________________________________ Home telephone no: _________________ Dialing code: ________ Applicants Cell no: _______________________________________ Applicants Email Address: _________________________________ Which address should we use for future correspondence?

_________________________________________________________ 4 To which Education Region does your school belong?

_________________________________________________________ 5 For purpose of mine visit: Shoe size ___________

Overall size ___________ 6 Person whom we can telephone to contact you urgently:

Name: __________________________________________________ Telephone no: ____________________ Dialing code: ___________

7 Name of parent or guardian:

FATHER: ______________________________________________________ Occupation: ____________________________________________________ Place of Work: __________________________________________________ Telephone no: ____________________ Dialing code: ___________ MOTHER: ______________________________________________________ Occupation: _____________________________________________________ Place of Work: ___________________________________________________ Telephone no: ____________________ Dialing code : ___________ 8 For interviews please tick () which centre is nearest to you: (it may be possible to interview you at the centre indicated) ( ) Bloemfontein ( ) Cape Town ( ) Durban ( ) Johannesburg ( ) Louis Trichardt ( ) Polokwane ( ) Port Elizabeth ( ) Pretoria ( ) Witbank

9 Place of birth: ____________________________________________ Date of birth: _____________________________________________ 10 Age in years this December: _________________________________ Identity Number: __________________________________________ Marital Status ( ) Single ( ) Married

11 SA Citizen ( ) YES or ( ) Permanent Resident 12 Do you suffer from a chronic or physical handicap?

( ) YES ( ) NO If yes, please give brief details:

_________________________________________________________ _________________________________________________________ 13 Have you been convicted of any crime/crimes?

If yes, please state which crimes you have been convicted of:

_________________________________________________________ _________________________________________________________

Bursary Schemes

 Anglo American PLC  Anglo Thermal Coal  ASA Metals  BHP Billiton  Coal of Africa  De Beers  Discovery Health  Gallagher Foundation  National Skills Fund  Optimum Coal  Petra Diamonds  PPC  Wits Gold Thank you for your application. We are pleased to inform you that you will be considered for an interview. Should you be successful you will be informed of the date and venue of this interview by telegram.

We regret to inform you that your application was not successful for the following reasons:

You are not a South African citizen or permanent resident. Your application was received after the closing date for Scholarships – 30 May

NB: We do not require prelim results. Grade 11 will suffice.

Based on our Manpower requirements for this year, we are not offering bursaries to students in your particular discipline or year of study.

Your application has not met our minimum requirements and you were not selected to proceed to the next stage of selection.

B. Education

1 Name of Secondary schools attended:

NAME OF SCHOOL DATES ATTENDED STANDARDS COMPLETED

Only to be completed by current Grade 12’s

Please give grade 11 and 12 results: Add additional subjects not listed

SUBJECT ACHIEVEMENT LEVEL CURRENT POSITION IN CLASS GRADE 11 GRADE 12 ENGLISH MATHEMATICS MATHEMATICS 3 MATHEMATICS LITERACY PHYSICAL SCIENCE OTHER OTHER OTHER OTHER OTHER

2 Have you completed Matric? ( ) YES ( ) NO If yes, please complete the following: Name of examination: ____________________________________ Year of exam: _______________________ Final Matriculation Results:

SUBJECT HG / SG SYMBOL SUBJECT ACHIEVEMENT LEVEL

3 If you are repeating some of your Matric examinations, please complete the following:

Name of centre / school you are attending: _______________________________ Examination date: ____________________

4 Have you undertaken any post-matric studies excluding full-time university? ( ) YES ( ) NO If yes, please give details of course you are studying at present and qualifications (if any) obtained:

____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 5 Are you attending university: ( ) YES ( ) NO If yes, please complete the following:

Degree which you hope to obtain: _______________________________________ Present year of study: ____________________ Year which you started your degree: _______________________________

* PLEASE ATTACH YOUR FULL ACADEMIC RECORD TO DATE OR YOUR APPLICATION WILL NOT BE CONSIDERED

C. Achievements

1 Give details of all your activities at school and university or in the community, and your role in them: e.g. leadership, sport, cultural, etc.

(Please include all details as we use this information for your interview CV for company bursary interviews)

SCHOOL / UNIVERSITY / COMMUNITY / ACADEMIC / SPORT / CULTURAL

2 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: (Please attach a separate sheet of paper if this space is not sufficient)

D. Career

1 Where did you find out about this bursary/scholarship?

( ) Newspaper / Magazine ( ) Career Talks ( ) Family / friends ( ) School / Teacher ( ) University handbooks ( ) Career exhibitions

2 Have you attended an interview with one of our client companies’ previously? ( ) YES ( ) NO

If yes, which one was it? ______________________________________________ Which year did you apply? ___________________ 3 Are you in receipt of any other scholarship, bursary or loan? ( ) YES ( ) NO

If yes, what is the name of the award? _____________________________________________________________ Does it carry an employment obligation? ( ) YES ( ) NO

4 Give details of working experience since leaving school, if applicable:

NAME OF ORGANISATION

DATE

TYPE OF WORK REASON FOR LEAVING

FROM TO

5 Have you ever visited a mine? If so, please give details of where, when and what your impressions were

(Only for those applying to mining companies):

6 Write a brief statement setting out clearly why you have chosen this degree and how you intend to use it after graduation:

Signed : __________________________________________________ Date : ____________________________________ I declare that to the best of my knowledge all the information on this form is true and correct

Notes and instructions

Please read these notes and instructions carefully before completing this form. Be sure to read every section and that the information you provide is accurate.

1 Application forms that are incomplete will be disregarded. Please ensure that you attach proof of academic results: current matriculants do not need to provide preliminary results – final grade 11 will suffice. The earlier you apply the better your chances.

2 Closing date for applications is 31 May.

3 Bursaries will only be allocated for next year.

4 You must supply all the information requested, or explain why you cannot provide it.

5 Applicants applying for bursaries with less than an achievement level of 6 in Mathematics and Science will not be considered for Engineering / Geology and Science degrees and a minimum achievement level of 6 for mathematics is required for accounting degrees. Mathematics literacy will not be accepted.

6 Do not send original documents, please attach copies.

7 Please note that as all our bursaries/scholarships are dependent on our client companies’ future manpower requirements, we do not always have bursaries for all disciplines. As this situation differs from year to year, we would advise you to re-apply the following year should you be regretted for this reason.

8 A passport size photograph of the applicant must be attached to the top right-hand of the front page.

9 Kindly fill in your name, postal address and postal code in the panel at the bottom of the front page.

10 Please fill in both your parents/guardians occupations so that we can evaluate your financial need level.

11 It is your responsibility to apply for entrance to university and for other options for financial support. We recommend that you apply to at least two universities and for many funding options/bursaries.

FOR YOUR INFORMATION WE WISH TO ADVISE YOU THAT OUR SELECTION PROCESS ON ACCEPTANCE OF YOUR APPLICATION CONSISTS OF TWO INTERVIEWS.

ANY CHANGE OF ADDRESS OR CONTACT TELEPHONE NUMBER

MUST BE FORWARDED TO US EMAIL AT [email protected] OR BY TELEPHONE (011) 484 7505