NOTES AND INSTRUCTIONS
This form must be completed in your own handwriting Incomplete application forms will not be considered Bursaries will only be allocated for the next calendar year Please note that as all our bursaries/ scholarships are dependent on our business and future manpower needs A passport size photograph of the applicant must be attached to the top right-hand of the front page It is your responsibility to apply for entrance to the university. We recommend that you apply to at least two universities No applications will be considered without the acceptance letter of the University If you have completed your 1st,2nd, or 3rd year you must obtain a minimum of 60% for each of your subjects, before we will consider your application. The following documents must accompany your application form: (Do not attach originals. Attach certified copies only) Proof of registration from the institution A certified copy of your Grade 12 certificate An updated official transcript of your academic record at the school, university or university of technology or a certified copy of such transcript. Copy of identity document. Copies of parent/guardian identity documents. Copies of parent(s)/ guardian(s) salary advice or affidavit if they are unemployed. Applications should be addressed to The Skills Development Facilitator, Nkomati Joint Venture, Box 562, Machadodorp, 1170. No correspondence will be entered into unsuccessful applications.

PLEASE TICK THE COURSE YOU WISH TO STUDY, OR ARE CURRENTLY STUDYING INDICATE YOUR 1st, 2nd AND 3rd CHOICE BY WRITING 1,2 & 3 IN THE APPROPRIATE RANKING COLUMN
{ √ }	COURSE	RANKING	{ √ }	COURSE	RANKING
Mining Engineering	Metallurgy (Extractive Only)
Electrical Engineering	Geology
Mechanical Engineering	Environmental
Chemical Engineering

SECTION A	PARTICULARS OF APPLICANT
Surname
Full name
Identity number
Gender	Ethnic group
Date of birth	Place of birth
Marital status	Age in years this December
Permanent resident in RSA	Yes	No	South African citizen	Yes	No
Do you suffer from any chronic disorder or physical handicap? If yes, please give brief details:	Yes	Have you been convicted on any crime(s)? If yes, please state what crimes you have been convicted of:	Yes
No	No
Permanent residential address in full ( no box numbers)	Address for future correspondence
Code	Code
Home contact number	Cell phone number
Person whom we can contact if we need to contact you urgently	Particulars of parent or guardian
Name of person	Name of person
Contact number	Contact number
Relationship	Relationship
Occupation
Place of work

Name of present university	Name of proposed university
Name & address of your present/ or last school	To which education region does your school belong?
Code

SECTION B	EDUCATION
Name of Secondary schools attended	Dates Attended	Grade Completed
PLEASE SPECIFY GRADE 10, 11 & 12 RESULTS

Subject	Symbols 1 to 7	Current position in class
Grade 10	Grade 11	Grade 12

HAVE YOU COMPLETED MATRIC? If yes, please complete the following:	YES
NO
NAME OF EXAMINATION	YEAR OF EXAM
SUBJECT	SYMBOL

HAVE YOU REPEATED SOME OF YOUR MATRICULATION EXAMINATIONS? If yes, please complete the following:	YES
NO
NAME OF SCHOOL/ CENTRE YOU ARE ATTENDING
SUBJECT	SYMBOL	EXAMINATION DATE

HAVE YOU UNDERTAKEN ANY POST-MATRIC STUDIES EXCLUDING FULL-TIME UNIVERSITIES? If yes, please give full details of the course you are studying at present and qualifications obtained	YES
NO

ARE YOU ATTENDING UNIVERSITY? If yes, please complete the following	YES
NO
Degree	Present year of study	Year in which you started	Options you will take in the final year

PLEASE ATTACH YOUR FULL ACADEMIC RECORD TO DATE

SECTION C	ACHIEVEMENTS
Give details of all your activities at school and in the community, and your role in them
School	Community

GIVE DETAILS OF ANY ACTIVITY (ACADEMIC OR OTHERWISE) IN WHICH YOU HAVE DONE WELL EITHER AT SCHOOL AND/ OR UNIVERSITY

HAVE YOU HAD A PART TIME JOB? If yes, please describe what you did and where you worked	YES
NO

SECTION D	POST MATRIC QUALIFICATIONS
Full name of highest qualification
Nature of qualification	Degree	Diploma
Status	Presently Studying	Discontinued
If discontinued, for what reason?
If presently studying, which year of study?	First	Third Year
Second Year	Fourth Year
Student Number
Name of institution
Contact number of the registrar’s office
Address of institution
Code

Major Subjects	Mark % Obtained
Auxiliary Subjects	Mark % Obtained

ARE YOU RECEIVING ANY OTHER BURSARY OR LOAN? If yes, please describe below the nature of financial assistance and any obligations involve and provide the name of the institution that granted the bursary/ loan assistance:	YES
NO

WILL YOU REQUIRE ACCOMMODATION? If no, state reason:	YES
NO

SECTION F	GENERAL
HAVE YOU APPLIED FOR BURSARY PREVIOUSLY? If yes, which one was it?	YES
NO
Which year did you apply?

DOES IT CARRY A SERVICE OBLIGATION? If yes, explain obligation:	YES
NO

GIVE DETAILS OF WORKING EXPERIENCE SINCE LEAVING SCHOOL?
Name of Organisation	Start Date	End Date	Roles & Responsibilities	Reason for leaving

HAVE YOU EVER VISITED A MINE? If yes, please give details of where and when, and what was your impressions:	YES
NO

BRIEF STATEMENT SETTING OUT CLEARLY WHY YOU HAVE CHOSEN THIS DEGREE AND HOW YOU INTEND TO USE IT AFTER GRADUATION?

I DECLARE THAT TO THE BEST OF MY KNOWLEDGE ALL THE INFORMATION ON THIS FORM IS TRUE AND CORRECT
SIGNATURE	DATE

RETURN ADDRESS
Please e-mail or fax your application to the contact details below: RECRUITMENT Attention: Anna Sithole
NAME	Recruitment	CONTACT NUMBER (TEL)	(013) 712 8375
E-MAIL ADDRESS	Recruitment@nkomati.co.za	CONTACT NUMBER (FAX)	(086) 544 8774