Bursary Form

MINE METALLURGICAL MANAGERS' ASSOCIATION OF SOUTH AFRICA
5th Floor, Chamber of Mines, 5 Hollard Street, Johannesburg 2001
All correspondence to be addressed to the Secretary
P O Box 61709, Marshalltown, 2107
Tel: (011) 498-7100
Fax: (011) 834-3804

BURSARY APPLICATION:to study at a TECHNIKON/ UNIVERSITY in South Africa for a diploma/ degree in Metallurgy or Chemical Engineering

APPLICANT

Surname: _____________________________________________________________________

Christian Name/s _______________________________________________________________

Postal Address: ________________________________________________________________

______________________________________________________________________________

I D Number: ___________________________________________________________________

Contact Telephone No: __________________________________________________________

Email Address : _______________________________________________________________

Date of Birth: ________________________ Place of Birth: _____________________________

High School Attended: __________________________________________________________

Town: ________________________________________________________________________

From: _________________________________ To: ___________________________________

Occupation since leaving school: __________________________________________________

Date of Matriculation Examination (month and year): ___________________________________

Date of University Entrance Examination: ____________________________________________

Field of study recorded on matriculation certificate (if any): _____________________________________________________________________________

BURSARIES (FOR TUITION FEES) ARE TENABLE AT ANY TECHNIKON/ UNIVERSITY IN THE REPUBLIC OF SOUTH AFRICA OFFERING STUDIES IN METALLURGICAL AND CHEMICAL ENGINEERING

Diploma/ Degree for which applicant is currently studying:

Metallurgical/ Chemical Engineering (Delete whichever is not applicable)

TECHNIKON/ UNIVERSITY at which applicant is attending:

_____________________________________________________________________________

Course of Study: ______________________________________________________________

Are you currently in receipt of a bursary? YES/NO (Delete whichever is not applicable)

If YES, please give details: _______________________________________________________

______________________________________________________________________________

NB : SHOULD YOU RECEIVE ANY FURTHER BURSARIES DURING THE COURSE OF THE YEAR, IT IS YOUR DUTY TO INFORM THE ASSOCIATION WHO RESERVES THE RIGHT TO REVIEW, AND POSSIBLY RESCIND, THE AWARD.

PARENT/ GUARDIAN (Delete whichever is not applicable)

Surname: ______________________________________________________________________

Christian Names: _________________________________________________________________

Residential Address: ______________________________________________________________

________________________________________________________________________________

Telephone Number: ____________________________

I HEREBY DECLARE THAT THE INFORMATION WHICH I HAVE MADE AVAILABLE TO THE MMMA IS TRUE AND CORRECT.

___________________________________
SIGNATURE:

______________________
DATE:

NOTES FOR BURSARY APPLICANTS
PLEASE PARTICULAR ATTENTION TO THE FOLLOWING:

Applicants who have completed one or more years of study at a technikon/university must attach a photocopy of the technikon’s/ university’s official statement of result obtained in each year-end examination, or in the case of being in their being first year, the mid year examination results will be required. Failure to do so may prejudice the application.
The number of students that can be accepted for a bursary is limited and applicants for the Association’s bursary are advised to make provisional registration at the technikon/university they wish to attend. On application for provisional registration, the technikon/university should be advised whether or not an applicant will enrol if his/her application for a bursary is unsuccessful.
Only forms in the applicants' own handwriting may be submitted. Faxed applications will not be considered.
Applicants who are in contention for the Association’s bursary, will be requested to appear before a Pre-Selection committee of the Association and will be advised of the interview.
All applications must be supported by a letter of recommendation from their last senior lecturer.
A letter motivating your need for a bursary must accompany this application form.
Applications may be in English or Afrikaans.
Applications for the Association’s Bursary close 31 October and application forms received after that date will not be considered.

Should any information furnished be found to be false then the Association reserves its right to withdrawal of the bursary and recovery of full costs, including legal costs where applicable.

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