APPLICATION FORM
FUNDZA LUSHAKA BURSARY
DECLARATION
I have read the detailed terms of conditions under which this bursary is to be awarded and agree to these
conditions if I am successful in my application.
This bursary is linked to a Service Contract and the Department of Education has the right to post the
graduated teacher in an area determined by national needs. Eligible applicants from rural areas will be
given equitable consideration.
This bursary is awarded only to Priority Teaching subjects as determined by the DoE as listed below:
a. Grades R-9: Foundation Phase; African Languages; English Language; Mathematics; Science;
Technology.
b. Grades 8-12: African Languages; English Language; Mathematics; Mathematical Literacy; Agricultural
Sciences; Life Sciences; Physical Science; Agricultural, Civil, Electrical, Mechanical, Information and
Computer Applications Technology; Engineering Graphics and Design.
If I do not fulfill the contract conditions, the bursary amount will need to be paid back at the specified
interest rate in the bursary contract.
I agree to these above terms and agree to sign the contract:
Signature of applicant
Date
Time
1.
PARTICULARS OF BURSAR
1.1
Surname :
1.2
Title :
1.3
First Names :
1.4
Identity Number :
1.5
Student Number: ____________________________________________________
1.6
Date of Birth :
1.7
Gender :
1.8
Marital status (i.e. single, married, divorced, widowed) :
1.9
Home address (postal) :
1.10
Home address (residential) :
1.11
Home telephone number : [area code]
1.12
Cellphone number :
1.13
Residential address while studying :
1.14
Telephone number while studying : [area code]
1.15
Fax No. [area code]
1.16
E-mail address :
2.
[number]
[number]
[number]
PARTICULARS OF PARENT OR LEGAL GUARDIAN
2.1
Surname :
2.2
First names :
2.3
Title :
2.4
Residential address :
2.5
Telephone number : [area code] _________ [number]
2.6
Cellphone number :
2
2.7
Full name of employer of parent or legal guardian :
2.8
Physical address of that employer :
3.
PARTICULARS OF UNIVERSITY
3.1
Name of University :
3.2
Course of Study : ____________________________________________________
3.3
Bursar Number :
To be filled in by Student Funding Office
4.
For which academic years of study do you wish to apply for the Bursary?
Qualification
1st year
1
BED
2
PGCE
3
Undergraduate
BA
4
degree
BSc
5
6
2nd year
3rd year
4th year
-
BCom
Other
Specify
undergraduate
______
degree
5.
In what year of study are you presently (2007)? (returning undergraduate students only)
1st year
2nd year
3rd year
4th
3
6.
The Bursar’s bank account details are :
6.1
Name of bank :
6.2
Branch :
6.3
Branch No.
6.4
Name of account :
6.5
Account No.
7.
Are you presently receiving a NSFAS Student Loan?
YES
NO
8.
NSFAS’ physical domicilium address :
9.
NSFAS’ fax number : [area code]
10.
NSFAS’ e-mail address :
[number]
4
PHASE SPECIALISATION
Do you wish to become a teacher in the “Primary” school or the “Secondary”
School?
11
12
Please tick where appropriate
Primary
(GET)
Foundation Intermediate Senior
GRADE
GRADE
GRADE
R-3
4-6
7-9
Secondary
(FET/ GET: Senior Phase)
GET
GRADE 7-9
FET
GRADE 10-12
On which campus will you enroll in 2007?
Please tick where appropriate
13
Edgewood
Pietermaritzburg
Howard College
Westville
Do you wish to study Part-time or Full-time?
Please tick where appropriate
14
Part-time
Full-time
Do you wish to be housed in University Residences?
Please tick where appropriate
YES
NO
ACADEMIC RECORD
15
Please attach to this application form written evidence of undergraduate
academic records, degree certificates or Matric Certificate to this application.
Proof of academic record provided:
YES
NO
5
TEACHING SUBJECTS
16
Which subjects would you like to teach?
Please tick where appropriate
16.1 The following “learning areas studies” are offered in the
“Primary School”
Which subjects would you like to teach?
Like to teach
Have the
necessary
background
For official
purposes

Literacy

Numeracy

Arts & Culture

Social Sciences

Life Orientation

Economic Management Sciences

Natural Sciences

Technology
16.2 The list below is the new ‘Secondary school” subjects.
Which subjects would you like to teach?
Like to teach
Have the necessary
background
For official purposes



























Agricultural Management Practices
Agricultural Science
Agricultural Technology
Dance Studies
Design
Dramatic Arts
Music
Visual Arts
Accounting;
Business Studies; and
Economics
Consumer Studies;
Hospitality Studies; and
Tourism
All official languages at Home and
First Additional Level
All official languages at Second
Additional Level and all languages
other than official languages at
Home, First Additional and Second
Additional Levels
Civil Technology
Electrical Technology
Engineering Graphics and Design
Mechanical Technology
Geography
History
Life Orientation
Computer Applications Technology
Information Technology
Life Sciences
Mathematical Literacy
6


Mathematics
Physical Sciences
7
17. MOTIVATION TO BECOME A TEACHER
Why do you wish to become a teacher?
Please ensure that you have completed ALL the appropriate sections in this
application form. Return this application form to
University of KwaZulu-Natal,
Faculty of Education
Admissions Officer
Private Bag X03, ASHWOOD
Telephone: 031 260 3414
Fax:
031 260 1109
OR
Leave this Application form at Room A123 Administration Building, Faculty of
Education, Edgewood Campus.
OR
Leave this Application Form with the Faculty Officer of the Faculty in which you
are currently registered.
CLOSING DATE: FRIDAY 09 February 2007
Please ensure that your application forms reach these officers as soon as
possible to assist in the processing of the applcaition.
8
Faculty of Education
APPLICATION RECORD
Student Name: _______________________________________
Student number: ______________________________________
Qualification enrolled for in 2007: _________________________
This is to certify that this student has made a formal application for a Fundza Lushaka
Department of Education Service Contract Bursary.
This application is being processed presently (February 2007)
This is not a guarantee that the bursary will be awarded.
Signature of Student: __________________________________
Date: ________________________________________________
Signature of Dean: _____________________________________
Date: ________________________________________________
Faculty Stamp
9