MQA BURSARY SCHEME

2017 APPLICATIONS

INSTRUCTIONS

1. Read carefully before completing, signing or submitting this form.

2. Ensure that this form is completed in full.
3. Complete in BLOCK LETTERS.
4. Note that this bursary cannot be used to pay for existing loans or debts.

CRITERIA

5. Applications are invited from Unemployed South African Citizens 35 years old or younger.
6. Ensure that this form is duly signed.
7. Application forms with incomplete and incorrect information and documentation will be
disqualified.
8. No faxed / emailed application forms will be accepted.

Hand Deliver completed forms to:

1. The Manager
Bursaries Unit
Mining Qualifications Authority (MQA)
7 Anerley Road
Parktown
JOHANNESBURG

2. MQA Regional Offices across the country

3. Your Institution - Where you received the application form

Posted to (by registered mail):

The Manager
Bursaries Unit
Mining Qualifications Authority (MQA)
PRIVATE BAG X118
MARSHALLTOWN 2107

www.mqa.org.za

www.mqa.org.za
 MQA BURSARY SCHEME
2017 APPLICATIONS
Surname: Names:

COMPULSORY DOCUMENTS THAT MUST BE SUBMITTED

1. Registration Documents (Tick if Submitted)

Certified copy of Senior Certificate (Grade 12) where available otherwise latest
A
Grade 12 results

B Statement of results or

Certified copy of the latest academic transcript or record on official letterhead or

C
logo (if you are already at university, university of technology or TVET College).

Printed proof of registration or acceptance letter from a university, university of

D
technology or TVET College where available.

2. Identity Documents (Tick if Submitted)

A Applicants certified copy of a valid South African identity document.

B Certified ID copies of both parent/s or guardian/s or spouse.

A certified copy of the death certificate if one or both of the parents is/are
C
deceased.

D An affidavit if the whereabouts of one or both parents are unknown.

3. Proof of Employment Documents (Tick if Submitted)

Salary advice (pay) slips of the parent/s or the guardian/s not older than three
A
(3) months.

B An affidavit if the parent or guardian is unemployed.

4. Proof of Residence Documents

Certified copy of proof of residence that is no older than three months,
A
Municipality Utility Bill or
B A stamped letter from a tribal authority, or a sworn affidavit to this effect.
For MQA Use: Verified & Captured By: Date:

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 MQA BURSARY SCHEME
2017 APPLICATIONS

SECTION A - PERSONAL DETAILS OF APPLICANT

1 ID Number

2 Surname

3 Full Names

4 Date Of Birth

5 SA Citizenship Yes No

6 Married Yes No

7 Employed Yes No

8 Gender Male Female

9 Race African Coloured Indian White

Yes No
10 Do You Have A If YES, please describe the nature of the disability:
Disability?

11 Place Of Birth

HOME Residential
12 Address - With Postal Code
Postal Code

Postal Address -
13 Postal Code
With Postal Code

14 District / Municipality Rural (Y/N)

15 Home Province
Contact Telephone Cellphone 1 Cellphone
16
Numbers 2
17 Email Address

Yes No
Have You Ever Been If yes, please specify the nature and date of offence:
18 Found Guilty Of A
Criminal Offence?

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 SECTION B LAST (HIGH) SCHOOL ATTENDED

Name Of School

School Address

Town & Province

4. Grade (Please tick) Currently in Grade 12 Completed Grade 12

5. Years attended From: To:

Higher Standard
6. Subjects (List them below) Symbol Symbol Percentage
Grade Grade

6.1

6.2

6.3

6.4

6.5

6.6

6.7

6.8

6.9

6.10

6.11

6.12
NB: Please Attach Proof Of The Latest Results.

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 SECTION C - TERTIARY EDUCATION
A) CURRENT INSTITUTION

University/TVET College:
______________________________________________________________

Year Commenced Studies: _________________ Academic year of Study in 2017 ________________

Student Number: ________________________________________

Degree / Diploma / Course: ___________________________________________________________

B) PREVIOUS INSTITUTION

Name of University / TVET College:

______________________________________________________

Student Number: ___________________________ Year Studies Commenced:

___________________

Degree/Diploma Course:
_______________________________________________________________

Have you repeated any year of study during your current or previous tertiary studies? Yes / No
If yes, state year/s and reason/s:

C) LATEST ACADEMIC RESULTS

Year of Semester/ %
Course / Subject Achieved
Study Trimester

Page 5 of 7
 NB: Attach Proof of Latest Academic Results or Academic Transcript/s (on institution
letterhead)

SECTION D - STUDIES AND FINANCIAL INFORMATION FOR THE

2017 ACADEMIC YEAR (Please mark with X)

1. University/College (Current or
applied to / accepted at)
Attach Proof of (Provisional) Registration or
Acceptance Letter

2. Qualification (Degree/Diploma) in
2017

3 Qualification in 2017 Degree Diploma

4 Year of Study in First Second Third Fourth

2017
TVET College Trimester 1 Trimester 2 Trimester 3
5 Qualification in
2017

Year MQA MQA

Are you a current Yes No Yes No
Bursary Bursa
6 MQA Bursary
First r in
Holder?
Awarded 2016?

Yes No If YES, describe the nature of financial

assistance and/or any obligations you have and
Are you in provide the name of the institution that granted
possession of any the bursary
7
other bursary or
loan?

Do you have
Outstanding Debt If YES, please provide the amount due and
8 Payable to the payable to the institution/s. State how the debt will
Yes No
current university / be repaid AND Please attach latest fees
TVET College statement.

Page 6 of 7
 The Historical Debt will be covered/paid as follows:

SECTION E PARENT(S) / GUARDIAN(S) / NEXT OF KIN

(Person Responsible for The Applicants Studies)

1 Surname

2 Full Names
3 Identity No.
4 Relationship Mother Father Other, specify:

Employer Unemployed (U)

5 Employment Status Pensioner (P)

Joint Family/Household
6 Income (Gross) per R
Annum

Residential Address
7 With Postal Code

Postal Address With

8 Postal Code

Contact Telephone Home Cellular

9 Numbers Including
Dialling Codes
Other
Work Contacts

10 Email Address

All the information provided is, according to my knowledge, TRUE AND CORRECT

11 Signed - Applicant Date

Assisted By:
12 (Parent/Guardian) Date

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