COGTA

BURSARY APPLICATION FORM

EXTERNAL BURSARIES: 2024

Name of the applicant: ____________________________________

University you intend to study at: _______________________

Name of the qualification which you are applying for: ____________________________

District Municipality: _________________________

Local Municipality: ___________________

Ward: _______________

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Instructions: Your completed Application Form must be accompanied with the following
documentation:

1) Certified copy of Matric certificate if you have completed your grade 12 or a copy
of your Grade 11 year end results and grade 12 half year results if you are still in
school.

2) Certified copy of your official academic record showing marks, symbols,

percentages obtained in all examinations if currently studying at a tertiary
institution.

3) Certified copy of your identity document and your parent’s/guardian’s ID’s.

4) Copy of acceptance letter from the tertiary institution for the intended qualification

5) Proof of non-acceptance by tertiary institutions in KwaZulu Natal if studying

outside of the KwaZulu Natal Province.

6) Copy of the curriculum (indicating the number of years of study, number of

modules/subjects to be taken) from the academic institution for the intended
qualification.

7) Printout from the academic institution of the tuition fees that will be required

8) Income and expenditure statement of parent/legal guardian. Proof of income must

be provided or a letter from the Department of Labour - parent/s stating that they
are unemployed.

9) Copy of certified death certificate/s of parent/s.

10)Proof of Residence

11)Letter of motivation (explain why you believe you are deserving of a bursary
outlining your circumstances).

* Please turn over to complete the form and ensure that the form is fully completed
and signed by student and parents.

* all documentation mentioned above must be attached.

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Please print when completing this form. Mark Submit the completed application form and
appropriate blocks with an “X” Failure to the relevant attachments to: The Bursary
complete this application form fully and Unit, Human Capital Development,
correctly may prejudice the applicant’s Department of Cooperative Governance and
chances of obtaining a bursary. Traditional Affairs, Private Bag X9078,
Pietermaritzburg, 3200 / Natalia Building,
330 Langalibalele Street, Pietermaritzburg.

PERSONAL PARTICULARS

FIRST NAMES:_____________________________________________________________________

SURNAME: ________________________________________________

IDENTITY NUMBER: _________________________ DATE OF BIRTH:___________________________

POSTAL ADDRESS: _________________________ PHYSICAL ADDRESS: ______________________

___________________________________________ _________________________________________

TELEPHONE NUMBER: (____)_________________ DISTRICT:________________________________

CELL PHONE NUMBER:_______________________ LOCAL MUNICIPALITY:__________________

ALTERNATE NUMBER:_______________________ WARD NUMBER:__________________________

FAX NUMBER:_______________________________ COUNCILLOR:_____________________________

NATIONALITY:_______________________________ MARITAL STATUS:

Single/Married/Divorced/Widowed

GENDER: Male/female DISABILITY: YES/NO__________________

If yes, please elaborate _________________
____________________________________

Are you currently employed? YES/NO If yes,

RACE: Black/Coloured/Indian/ White please elaborate_______________________
____________________________________

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Have you ever been convicted of a criminal Did you consult a vocational counsellor
offence, dismissed from employment or regarding your choice of study?
requested to resign? YES/NO
If the answer is yes please furnish full details YES/NO
on a separate sheet of paper.
Have you previously received a Public Service Bursary? YES/NO

If yes – for which year and how long? ____________________________

Are/were you in possession of another bursary/scholarship/financial aid? (i.e NSFAS) YES/NO

If the answer is yes please indicate the name of the donor: _______________________

Obligations attached to bursary/scholarship/financial aid: ________________

_______________________________________________________________________________

Do you have any other tertiary qualifications: ___________________________________________

If yes please list the qualifications obtained: ____________________________________________

Name of the degree or diploma which you are applying for:

_______________________________________________________________________________
_______________________________________________________________________________

What will the major subjects be for the degree or diploma?

_______________________________________________________________________________

Number of years you intend studying for:

_______________________________________________________________________________

Name of tertiary institution you intend studying at:

______________________________________________________________________________

Provisional acceptance from the tertiary institution at which you intend studying

Received or Not Received:________________________________________________________

QUALIFICATIONS
Highest standard passed: Name of school attended:
_____________________________________
Town/city:
_____________________________________

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UNIVERSITY AND/OR OTHER POST SCHOOL TRAINING/STUDIES

List the subjects passed thus far: Address of institution/college:

____________________________________ __________________________________
____________________________________
____________________________________ __________________________________
____________________________________ __________________________________
____________________________________ __________________________________
____________________________________ __________________________________
____________________________________ __________________________________
____________________________________ __________________________________
____________________________________ __________________________________
__________________________________

Current year of study: Name of degree/diploma:

______________________ __________________________________
__________________________________

What is the remaining duration of your current List the subjects that still need to be completed
studies as prescribed by the tertiary institution? to obtain the relevant qualification:
____________________________________ __________________________________
____________________________________ __________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________

Please indicate the year you started studying for Have you ever failed any year of study?
the current course of studies: YES/NO
_______________________________________
Which year? _______________________

Have you rewritten the examination/s for the Student number at current institution:
subject/s failed? If yes, please indicate the date
of the examination: _____________________________________
_______________________________________
_______________________________________

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Full name of parents/legal guardians :

Father:
_______________________________________________________________________________
Mother:

Contact details of parents/legal guardians:

Father: Tel Number:___________________ Cell phone number:_____________________

Mother Tel Number:___________________ Cell phone number:_____________________

Address of parents/legal guardians:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Employer of parents/legal guardians:

Father:
_______________________________________________________________________________
_______________________________________________________________________________

Mother:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Address of employer of parents/legal guardians:

Father:
_______________________________________________________________________________

_______________________________________________________________________________

Mother:
_______________________________________________________________________________

_______________________________________________________________________________

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REVIEW, SUSPENSION AND EXTENSION

The Provincial Administration reserves the right, at any time and on any terms or conditions to:

a) review the continuation of the bursary; or

b) suspend the bursary; or

c) having suspended the bursary, reinstate the bursary; or

d) Extend the period of the bursary.

DECLARATION
I understand that this application for a bursary is not a loan and declare that the above particulars
are complete and correct.

___________________________________ ________________
SIGNATURE OF APPLICANT DATE

____________________________________ ________________
WITNESS DATE

SIGNATURE OF PARENTS/LEGAL GUARDIANS:

__________________________________ __________________________________
MOTHER FATHER

DATE: _______________________________

___________________________________ ________________
WITNESS DATE