Financial Support Services
FUNZA LUSHAKA BURSARY 20……….
INFORMATION AND APPLICATION FORM / RE-APPLICATION FORM
PARTICULARS OF STUDENT STUDENT NUMBER Maiden surname, if applicable First names Identity number Date of Birth ATTACH CERTIFIED COPY OF ID Race – for statistics only (tick one block)
d
d
M
M
African
Y
Y
Y
y
Gender (tick one block)
Coloured
Male
Indian
Female White
Other (please specify) Home Language (tick one block)
African Language
Afrikaans
English
Home Address Postal Code Home telephone number
Area Code
Number
Cell phone
Postal Address while studying Postal Code Telephone number while studying
Area Code
Number
Cell phone
E-mail address
PARTICULARS OF NEXT OF KIN Surname Relation (mother, father, brother, sister etc.)
Initials
Title
Next-of-kin Residential Address Postal Code Next-of-kin telephone number
Area Code
Number
Cell phone
PARTICULARS OF HIGHER EDUCATION INSTITUTION AND STUDY PROGRAMME On which campus are you registered? (tick one block) Degree (tick one block) B.Ed Phase specialization (tick one block) Foundation Phase
Potch Campus
Vaal Triangle Campus
B.Tech Intermediate Phase
B.A.
B.Comm
Senior Phase
FET
If Foundation Phase, are you able to teach in an African language (tick one block) If YES, in which African language? Year of study in 2013 (tick one block) 1st 2nd
3rd
Mafikeng Campus B.Sc Intermediate & Senior
Senior & FET
YES
NO
4th
PGCE
PGCE year
TEACHING SPECIALISATIONS Please indicate which priority areas you will be specializing to teach. Tick a maximum of 2 learning areas and/or subjects Foundation Phase (Grade R-3) Foundation Phase Specialisation African Languages
Intermediate Phase (Grade 4 – 6) African Languages English Language Mathematics Natural Sciences Technology
Senior Phase (Grade 7 – 9) African Languages English Language Mathematics Natural Sciences Technology
FET Phase (Grade 10 – 12) African Languages English Language Mathematics Mathematical Literacy Agricultural Sciences Agricultural Technology Civil Technology Computer Applications Technology Electrical Technology Engineering Graphics and Design Information Technology Life Sciences
Mechanical Technology Physical Sciences Accounting Economics Geography
FUNZA LUSHAKA BURSARY RECEIVED IN PREVIOUS YEARS Did you receive a Funza Lushaka bursary in previous years? (tick one block)
YES
NO
Did you receive a Funza Lushaka bursary last year? (tick one block)
YES
NO
DECLARATION BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE FUNZA LUSHAKA BURSARY CONDITIONS. I HAVE READ AND UNDERSTOOD THE CONTENT OF THIS APPLICATION. THE INFORMATION SUPPLIED IS TRUE AND CORRECT.
SIGNED by the STUDENT at ........................................................................................................ on this .............................. day of .................................................................. 20..
................................................................................................ (STUDENT SIGNATURE)
VERY IMPORTANT NOTES THAT APPLY TO THE COMPLETION OF THE APPLICATION FORM
1. 2. 3. 4. 5.
6.
7. 8.
THIS DOCUMENT IS THE APPLICATION FORM. IN ADDITION TO COMPLETING AND SUBMITTING THIS APPLICATION FORM, ALL APPLICANTS MUST REGISTER ON THE FUNZA LUSHAKA WEBSITE. REGISTRATION ON THE FUNZA LUSHAKA WEBSITE WILL COMMENCE FROM THE END 2012. FAILURE TO REGISTER MAY RESULT IN DISQUALIFICATION OF THE APPLICATION. FUNZA LUSHAKA IS ASSEMBLING A NATIONAL DATABASE OF ALL APPLICANTS AND THEREFOR NEEDS EVERY STUDENT’S DETAILED INFORMATION. (WEB ADDRESS AT BOTTOM OF PAGE) IN ADDITION, EVERY SUCCESSFUL APPLICANT WILL HAVE TO COMPLETE AND SUBMIT A LEGAL BINDING CONTRACT BEFORE THE BURSARY WILL BE ALLOCATED TO THE STUDENT ACCOUNT. SUCCESSFUL APPLICANTS WILL BE NOTIFIED BY THEIR FINANCIAL AID OFFICE DURING 2013 OF HOW AND WHERE THE CONTRACT MUST BE OBTAINED. The bursary is only awarded to South African citizens and this application will not be considered unless a certified copy of the applicant’s ID document as well as a printout of the online application is attached to this application form. The Department of Education prefers to use e-mail or SMS as means to communicate with bursars and should you be awarded or re-awarded the bursary, you will be expected to have an e-mail address and if possible a cell phone contact for SMS purposes. The bursary will only be awarded if the student’s academic performance is in compliance with Funza Lushaka’s predetermined requirements and one of the priority area specialization subjects is included as a teaching subject in your qualification. Once informed that you qualified, you will be required to take up a provincial teaching position and you will not be granted permission to defer this contractual obligation to continue with full-time studies. Nor will you be granted permission to take a “gap year”. One of the contractual obligations of this bursary is that you are required to teach in a provincial teaching post and you are free to choose the province in which you would prefer to teach. However, should the province of your choice not be able to offer you a post, then you will be offered a post in any of the other provinces and to meet your contractual obligations, you will have to accept the offer. The bursary must be repaid if the recipient fails to qualify, fails to apply for a teaching post with a provincial education department at a school, fails to take up a teaching post with a provincial education department at a public school, leaves a teaching post with a provincial education department before the end of the contracted service period, or otherwise fails to meet a requirement of the bursary agreement. The amount that is repayable is the full amount of the bursary received under the programme, less one year’s funding for every year spent teaching at a public school. Interest will be charged at the rate determined by NSFAS from time to time, which is always less than the commercial rate. The bursary is awarded for one academic year at a time. Upon receipt of academic results conforming to Funza Lushaka’s predetermined requirements, the bursary may be renewed each year until the recipient of the bursary has qualified as a teacher. Recipients of bursaries will be required to teach one year for every year the student received the Funza Lushaka bursary.
TEACHING PREFERENCE Eastern Cape North-West
If you should qualify, in which province would you prefer to teach after graduation? (Tick one block) Northern Cape Western Cape Mpumalanga Free State Limpopo KwaZulu-Natal
Gauteng
CLOSING DATE FOR APPLICATIONS Prospective Students : 30 November (preceding year) Senior Students : 15 October (preceding year) MAFIKENG : Thabang Matabane Tel: (018) 389-2300 E-Mail:
[email protected] Private Bag X2046, MMABATHO, 2735 Great Hall, Room 101
CONTACT PERSON FOR ENQUIRIES ON YOUR CAMPUS POTCHEFSTROOM : Triens Jacobs Tel: (018) 299-2047 E-Mail:
[email protected] Private Bag X6001 POTCHEFSTROOM, 2520 Building F19
VAAL TRIANGLE : Tumi Mokoena Tel: (016) 910-3134 E-Mail:
[email protected] PO Box 1174 VANDERBIJLPARK, 1900 Building 24, Room G52
FUNZA LUSHAKA WEB ADDRESS: www.funzalushaka.doe.gov.za FSBRV/FSS BURSARIES/FUNZA/POTCH
