FUNZA LUSHAKA BURSARY PROGRAMME 2020 Application Form

FUNZA LUSHAKA BURSARY PROGRAMME

2020 Application Form

[For use by 1

st

time bursary applicants who are unable to apply

through the website:www.funzalushaka.doe.gov.za]



Complete the form in detail.



All areas with * are compulsory to complete.



Read the attached application notes before you complete this

form.

N.B. Please ensure that this form is submitted to your Nearest District Office together with a certified copy of your ID

document. Do not submit/post it to the Department of Basic Education.

PARTICULARS OF STUDENT:

Surname

*

First names

*

Title*

Identity Number

*

Date of Birth*

D

M

Y

Gender(tick one block)

*

Male

Female

Maiden surname, if applicable

Home Language

*

(tick one block)

African language

Afrikaans

English

( pl e a s e s p e c i f y )

Ot her (please s pecify)

Race*- for statistical

purposes only

(tick one block)

African

Colour ed

Indian

White

e-Mail

HOME ADDRESS DETAILS:

House number and street

name

Suburb/Village/Township

*

Town (Nearest)/City

*

Postal

Code

*

Home telephone number

Area

Code

Number

Cell Phone Number of

somebody at home

ADDRESS WHILE STUDYING DETAILS:

House number and street

name

Suburb/Village/Township

*

Town (Nearest)/City

*

Postal

Code

*

Telephone number while

studying

Area

Code

Number

Personal Cell phone

(Please attach a certified copy of your ID book)

NEXT OF KIN DETAILS:

Next of kin

Surname

*

Next of

kin

Initials

*

Relationship

*

(mother, father, brother, sister etc.)

House Number and Street

Name

Suburb/Village/Township

*

Town (Nearest)/City of

next of kin

*

Postal

Code

*

Telephone number

Area Code

Number

HIGHER EDUCATION INSTITUTION AND COURSE DETAILS:

Name of Institution

*

Campus

Degree

*

(tick one

block)

B. Ed

B. Tech

B. A

B. Comm

B. Sc

PGCE

B. Soc.S c

B. Mus

B.FA

Phase Specialization

*

(tick one block)

Foundation

Phase

Intermedi ate

Phase

Senior

Phase

FET

Intermedi ate

& Senior

Senior &

FET

If Foundation Phase, are you able to teach in an

African language? (tick one block)

YES

NO

If YES, in which African language?

Please indicate which priority areas you will be specializing to teach. Tick a maximum of 2 learning areas and/or subjects.

[You may select more than one (1)Maximum is four (4)]

Foundation

Phase

(Grade R- 3)

Intermediate

Phase

(Grade 4 – 6)

Senior

Phase

(Grade 7 – 9)

FET

Phase

(Grade 10 –12)

Foundation

phase

specialisation

African Languages

Indicate Language e.g. IsiNdebele

Indicate Language e.g.

IsiNdebele

Indicate Language e.g. IsiNdebele

English Language

Accounting

Mathematics

Agricultural Sciences

Natural Sciences

Agricultural Technology

Technology

Civil Technology

Computer Applications

Technology

Economics

Electrical Technology

Engineering Graphics

and Design

English Language

Geography

Information

Technology

Life Sciences

Mathematical Literacy

Mathematics

Mechanical Technology

Physical Sciences

Student Number*

Year/Level of study

in 2021* (tick one

block)

1st

2nd

3r d

4t h

PGCE year

In what year did you complete your school leaving

examination? e.g. 2019 *

Is this your first -ever application for Funza Lushaka

bursary?*

Yes

No

Please confirm that you are applying for a Fu nza Lushaka

bursary for the 2021 academic year*

Yes

No

DECLARATION*

BY SIGNING BELOW I ACKNOWLEDGE THATI HAVE READ AND UNDERSTOOD THE FUNZA LUSHAKA BURSARY CONDITIONS AS WELL AS

THE CONTENT OF THIS APPLICATION. THE INFORMATION SUPPLIED IS TRUE AND CORRECT.

SIGNED by the STUDENT at …………………………………………………………… on this ………………. day of ………………………….. 20…………..

…………………………………………………………………

(student signature)