Group Five | Structured Ingenuity - Career Opportunities

PART 1/10 - BURSARY APPLICATION FORM

Fields marked with a * are compulsory.

Reference Number: Full Name: Gender: * Male Female Race:	Please indicate degree you are applying for: BSC: Quantity Surveying BSC: Civil Engineering BSC: Construction Management BTech: Civil Engineering BTech: Building Science BTech: Quantity Surveying BSC: Chemical Engineering BSC: Electrical Engineering BSC: Mechanical Engineering BTech: Construction Management BTech: Building management

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Surname: * First names: * Known as: Date of birth: / / Nationality: *	ID No.: * Home Language: Marital status: Married Single Do you have a disability? If so, state type:

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Residential Address: * Postal code: Postal Address: Postal code:	Tel. (H): Tel. (W): Cell no.: Cell (Alt): Email:

Father's occupation: Father's employer: Mother's occupation: Mother's employer: Has any family member received a Group Five bursary: Yes No	If any family member has received a Group Five bursary, please give particulars below: Name of bursary holder: Relationship with you: Name of institution: Year of study:

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Highest school grade: * Year: * Name and address of school:	Please specify subjects taken and their examination results: SUBJECT - HG/SG - % attained (e.g. Maths - HG - 70%) Please upload document containing relevant academic records (certificates and IDs etc.):

Academic records: University - Period (From date to end date) - Degree/Diploma (e.g. UNISA - 20 January 2008 to 20 October 2009 - Diploma)	Please upload document containing your university academic records:

Employer name and address:	Position held: Period: From date to end date

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Type of Degree: * Year of study for which bursary is needed: *	Number of years to completion of studies: * Name of institution you attend/will attend: *

Achievements e.g. awards, prizes, leadership positions etc.: Sports activities:	Hobbies & Special Interests:
Subject:

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I confirm that the information contained in this application is to the best of my knowledge, correct and truthful and I understand that if it is not, I may be eliminated from consideration in the selection process. If, after being admitted to the training scheme, any falsehoods or omissions are discovered in my application, I understand that my Bursary Agreement may be terminated. Confirm *