BASF South Africa Trust
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Bursary Application Form
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1
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Pre-Qualifying Questions 1/2
Gender
Select
Male
Female
Criminal Record
Select
Yes
No
Have you matriculated?
Select
Yes
No
Are you a South African citizen?
Select
Yes
No
Race(According to the BBBEE code)
*
Select
Black African
Coloured
Indian
Asian
Other
Total household income range
*
Select
R0 - R650 000
>R650 000
Pre-Qualifying Questions 2/2
I confirm that I am in possession of all the required supporting documents and will be able to submit them as part of my bursary application, including:
Certified copy of ID document
Matric Certificate
Academic Results / Transcripts
Parents Payslip(s)/Bank Statement(s)/Affidavit(s)- To show source of income
Any supporting documents (Curriculum Vitae (CV), Textbook Invoice(s), Acceptance Form, Means Test Documentation, etc.)
I understand that I must have all the relevant documents listed above available before proceeding with this application.
You must confirm that you have all the required supporting documents before proceeding.
Section A - Personal Details
Full Name
*
Date of Birth
*
ID Number
*
Attach ID document
Contact Number
*
Alternative Number
Email Address
*
Residential Address
*
Province
*
City
*
Any Disability?
*
Select
No
Yes
If yes, specify
Section B - Academic Information
Institution Name
*
Select Institution
University of Cape Town
University of the Witwatersrand
University of Pretoria
University of Johannesburg
Stellenbosch University
University of KwaZulu-Natal
North-West University
Sefako Makgatho Health Sciences University
University of South Africa
University of Venda
Walter Sisulu University
Central University of Technology
Mangosuthu University of Technology
Tshwane University of Technology
Vaal University of Technology
Sol Plaatje University
University of the Western Cape
Rhodes University
University of the Free State
Nelson Mandela University
Cape Peninsula University of Technology
Durban University of Technology
University of Zululand
University of Mpumalanga
University of Fort Hare
University of Limpopo
Other
If other, specify
Student Number
*
Field of Study
*
Current Year
*
Qualification Level
*
Select
Undergraduate
Postgraduate
Qualification Type
*
Select
Diploma
Advanced Diploma
Degree
Honours
BTech
Other
If other, specify
Expected Graduation Year
*
Average pass mark for completed modules(%)
*
Full University Transcript
Historic Debt?
*
Select
No
Yes
Proof of Debt (If Yes)
*
High School Details (Matric)
Name of High School
*
Math Mark (%)
*
Physical Science Mark (%)
*
English Mark (%)
*
Matric Certificate
*
Section C - Parent / Guardian Details
Do you stay with your parents?
*
Select
Yes
No
If no, who do you stay with?
*
Parent/Guardian 1 - Name
ID Number
Relationship
Source of income
Select
Employed
Self-Employed
Unemployed
Upload Document
Department
Position
Gross Income
Add Guardian 2
Parent/Guardian 2 - Name
ID Number
Relationship
Source of income
Select
Employed
Self-Employed
Unemployed
Upload Document
Department
Position
Gross Income
Section D - Any Other Supporting Documents
Other Supporting Documents/Merged Documents
Section E - Financial Need
Total Household Gross Income
Funded by NSFAS?
*
Select
Yes
No
If No, how are you funded?
*
Section F - Motivation Statement
Motivation statement (Be specific, authentic, address how funding will help achieve your goals and help you contribute to community) Max-250 words
Section G - Consent & Signature
I confirm that I have read and understood the
Declaration
and the
POPIA and Consent
and hereby provide my consent.
Applicant Signature (type full name)
Date
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