Fellowship Application Form 2014 - University Of Cape Town

3y ago
12 Views
3 Downloads
902.65 KB
18 Pages
Last View : 9d ago
Last Download : 2m ago
Upload by : Sabrina Baez
Transcription

Fellowship Application Form 2014For learners currently in Grade 12PrerequisitesIndication of entrepreneurial flair and passionCitizenship of South AfricaBelief in the future of the countryAmbassador of the Foundation's intended profile, namely demonstrating:Spirit of Significance, Intellectual Imagination, Achievement Excellence,Personal Initiative and Courageous CommitmentIntention to study for a Commerce, Science (excluding Medicine), Engineering, Law or Humanities(majoring in Politics, Philosophy OR Economics) degree at the University of Witwatersrand,University of Johannesburg, University of Cape Town, Nelson Mandela Metropolitan University,Rhodes University, University of the Western Cape, Stellenbosch University and Universityof PretoriaAcademic Requirements:- Minimum C (Level 5) in Pure Mathematics for Grade 11 results,- Minimum B (Level 6) average for Grade 11 results (excluding Life Orientation)Certified copies of Academic/extra-curricular awards/recognition must be provided for Grade 10, 11 and 12Candidates must not be older than 21 years of age in 2014.Application deadline 30 April 2014 by 12h00Post to:Allan Gray Orbis FoundationFreepost no: CB 11349Kloof Street, 8008Hand Deliver to:46 Hof Street, Oranjezicht, Cape Town OR8th Floor, Forum Building, 2 Maude Street,Sandton, JohannesburgPage 1 of 18

Important note to applicantsThe Allan Gray Orbis Foundation seeks to promote progress through entrepreneurship in an integrated SouthernAfrica. The Foundation aims to achieve this mission by identifying, educating and equipping demographicallydiverseindividualsthe potential to excel and make a significant future impact as high impact eneurs. ducatingandequippingdemographicallydiversewhoAll Theshortlistedcandidatesare requiredto haveindependentlywrittenthe NationalBenchmarkTestsindividuals(NBT) reimpactashighimpactresponsibleentrepreneurs.and Maths) by 31 July 2014. Additional information on the National Benchmark Tests can be obtained from your rarebyrcalling650independently3523. FailurewtorittenwriteNBTby dation ldisseminatenot disseminateany personalinformationunless aspecificallyauthorised16 of this application. SubmissionthisformtheAllan GrayOrbis Foundationdoes tNOTautomaticallythat t)willinbeorderawardedthedAllanGray o make applications to otherscholarships and/or bursaries in order to avoid disappointment should this application be unsuccessful. Faxedand/ore- Faxedand/or e-mailed copies of the application form will NOT be accepted. Please ensure that you submit theconsidered.application form in good time in order to meet the application deadline. Application forms received after 30 April 2014 otherrelevantdocumentsforyourownrecords.(12H00) will NOT be considered. retain86123a9copy235of your completed application form and other relevant documents for your own records.Email:fellowship@allangrayorbis.orgAllan Gray Orbis Foundation contact details:Website:www.allangrayorbis.orgTel:086 123 ceivearesponse.Kindly note: Please direct all queries to the contact details provided above. Queries posted on social media platformse.g. Facebook or Twitter will not receive a response.2014 Selection ProcessStep 1Submit completed application form30 April 2014Step 2Fellowship candidates expected to write the NationalBenchmark TestsAQL and Mathematics Test by31 July 2014Step 3Shortlisted applicants will be invited to a face to face interviewJuly – August 2014Step 4Shortlisted candidates will be invited to a Selection CampSeptember or November 2014Please note that applicants will be contacted after each step of the selection process to notify them of theirapplication status.Allan Gray Orbis Foundation Fellowship application form 2014 Learnerscurrently in Grade 12Page 2 of 18

pplicationYou will need to make sure that all requirements are carefully met and ullymetmetandandthetheYoucorrectinformationis providedso thatyour applicationcan be plicationcanbeprocessed.correct information is provided so that your application can be processed.! Certified copy of your IDCertifiedcopycopyofofyouryourIDID!! Certified! Certified copy of your final Grade 10 Grade1010reportreport!! Certified! Certified copy of your final Grade 11 Grade1111reportreport!! Certified! Latest Grade 12 report (where hereavailable)available)!! Latest! Recent passport size photograph!! Recent! Minimum C (Level 5) in Pure Mathematics for Grade 11 !! Minimum! Minimum B (Level 6) Average for Grade 11 results (excluding Life udingLifeLifeOrientation)Orientation)!! Minimum! Certified copies of Academic/Extra-curricular ular awards/recognition/supporting!! Certifieddocumentationobtained in Grade 10, 11 and edGrade10,10,1111andand1212obtainedininGrade! documentationStamped and signedreferencefrom anEducatorenclosed with application withwithapplicationapplicationinin! arately sealed envelopeseparatelysealedsealedenvelopeenvelope! separatelyI am currentlyin Grade 12 or! I amI amcurrentlycurrentlyininGradeGrade1212 or!! I have taken a gap year after olschool!! I Ihave! Parents/ Legal guardian signature (page ignature(page(page15)15)!! Parents/! Applicants signature (page !! ApplicantsATTACH A RECENTPASSPORTSIZEDATTACHA RECENTATTACHA ANTPHOTOGRAPHPHOTOGRAPHAPPLICANTOFOFAPPLICANTFor Official Use:ForOfficialOfficialUse:Use:ForApplication mber:AGMYou will needYouto makewill needsuretothatmakeall srAGMAGMcorrect informationcorrect isinformationprovided sois rtified!copyCertifiedof your copyID of youIneligible! Certified!copyCertifiedof your copyfinal Gradeof you! Latest Grade! Latest12 reportGrade(where12 repoav! Recent passport! Recentsizepassportphotographsize! Minimum!C (LevelMinimum5) inCPure(LevelMat5)1. APPLICANT(Factual information about yourself)Title: Mr / Miss / Ms / (Please circle the appropriate option)Surname:Title:Mr / Miss / Ms / (Please circle the appropriate option)Surname:Date of birth: D D M M Y Y Y YSurname:Date of birth: D D M M Y Y Y YCountry of citizenship:DD MMYYYYCountryof citizenship:Dateof birth:! Certified!copyCertifiedof your copyfinal Gradeof youAPPLICATIONAPPLICATIONFORMFORMAPPLICATION1. APPLICANT(Factual FORMinformation about yourself)Mr / Miss / Ms(Factual/ (Please circlethe appropriate1.Title:APPLICANTinformationabout option)yourself)! Minimum!B (LevelMinimum6) AverageB (Levelfor6)! Certified!copiesCertifiedof Academic/Extrcopies of AcFirst name(s):documentationdocumentationobtained in GradeobtaiFirst name(s):Middle Names:! Stamped!andStampedsigned referenceand signedfrFirstname(s):MiddleNames:separately sealedseparatelyenvelopesealed enGender: Male / Female (Please circle the appropriate option)Gender:Male / Female (Please circle the appropriate option)MiddleNames:! I amcurrently! I amin Gradecurrently12 in GraRace: Black / White / Coloured / Indian/ AsianRace: Black// White/ Coloured/ Indian/ Asian option)Gender:MaleFemale(Please circlethe appropriate(Pleasecirclethe appropriateoption)! I have taken! Iahavegap yeartakenaftera gapschy(Please circle the appropriate option)Race:Black / White / Coloured / Indian/ Asian!! Parents/LegalParents/guardianLegalsignaturguardID / PassportNo:Countryof citizenship:ID / Passport No:(Please circle the appropriate option)! Applicants! signatureApplicants(pagesignature15)Home AddressPostal addressAddressPostal addressIDHome/ PassportNo:Street Name & No:P.O BoxHomePostaladdressStreetAddressName & No:P.O BoxSuburb / Township / Village:Suburb / Township / Village:StreetName& No: / Village:P.OBox / Township / Village:Suburb/ TownshipSuburbCity:City:SuburbSuburbCity: / Township / Village:City: / Township / Village:Province:Province:City:City:1. APPLICANT1. APPLICANT(Factual e:Province:Country:Country:Title: Mr / MissTitle:/ MsMr//(PleaseMiss /circleMs /thPostal Code:Postal Code:Country:Country:Postal Code:Postal Code:Surname: Surname:Home phone:Cell:PostalCode:PostalCode:Home phone:Cell:E-mail Address:Home language:D ofDbirth:MDMDYDate of birth:DateE-mailAddress:Home language:Homephone:Cell:Second language:Other languages:Country of citizenship:Country of anguage:languages:Preferred method of contact: Post / Email / Home phone / Cell (Please circle the appropriate edmethod of contact: Post / Email / Home phone / Cell (Pleasethe appropriate option) ID / PassportIDNo:/ Passport n Fellowshipapplicationform2014 L e a r n e r sFFoundationoundation Fellowshipapplicationformform20142014 L e a r Learnersn e r scurrentlyinGrade1212Allan Fellowshipapplicationcurrentlyin GradePage 3 of 18Preferred method of contact: Post / Email / Home phone / Cell (Please circle the appropriate option) Home yOrbisFGoundationpplicationformr12.indd3 Fellowshipapplicationform2014 L e a r n e r scurrentlyinGrade12Street NameStreet& No: Name & No:Page3of182013/01/2411:55AM

2. EMERGENCY CONTACT DETAILS (Should we need to contact you needto contactyou urgently)2. EMERGENCYDETAILS(Shouldwe needcontactyou urgently)Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)First name(s):First name(s):1st contact number:1st contact number:2nd contact number:2nd contact number:3. PARENT OR GUARDIAN DETAILS (1)(Information about your parent or legal guardian)3. PARENT OR GUARDIAN DETAILS (1)(Information about your parent or legal guardian)Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)Surname:Surname:Country of citizenship:Country of citizenship:Relationship to applicant:Relationshipto applicant:(e.g. Mother, Father,Aunt)(e.g. Mother, Father, Aunt)Surname:Surname:Relationship to applicant: (e.g. Mother, Father, Aunt)Relationship to applicant: (e.g. Mother, Father, Aunt)First name(s):First name(s):Date of birth: D D M M Y Y Y YDate of birth: D D M M Y Y Y YParent / Guardian (Please circle the appropriate option)Parent / Guardian (Please circle the appropriate option)Marital status: Single / Married / Divorced / WidowedMaritalstatus:Single / option)Married / Divorced / Widowed(Please circlethe appropriate(Please circle the appropriate option)Occupation:ID / Passport No:Occupation:ID / Passport No:Home AddressHome AddressStreet Name & No:Suburb / Township / Village:Street Name & No:Suburb / Township / Village:City:Province:City:2.EMERGENCY CONTACT DETAILS (ShouldProvince:we need to contact you urgently)Country:Postal Code:Country:Postal ropriateoption)E-mailE-mail address:Firstname(s):Surname:Home phone:Cell:Cell:Home unt)st1Workcontactnumber:phone:Fax:Fax:Work phone:ndPreferredmethodof contact: Post / Email / Home phone / Work phone / Cell (Please circle the appropriate option)2Preferredcontactnmethodumber:ofcontact: Post / Email / Home phone / Work phone / Cell (Please circle the appropriate option)PARENT OR GUARDIAN DETAILS (2)(Information about your parent or legal itle: Mr / Mrs / Ms / Dr (Please circle the appropriate option)First name(s):Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)First name(s):Title: Mr / Mrs / Ms / Dr (Please circle the appropriate option)First name(s): D D M M Y Y Y YDate of birth:Surname:Date of birth: D D M M Y Y Y YSurname:Surname:DD MMYYYYDateof /birth:Country of citizenship:ParentGuardian (Please circle the appropriate option)Country of citizenship:Parent / Guardian (Please circle the appropriate option)Countryof citizenship:ParentGuardian(Pleasecircle the /appropriateRelationshipto applicant:Marital /status:Single/ MarriedDivorcedoption)/ WidowedRelationshipto applicant:Maritalstatus:Single / option)Married / Divorced / Widowed(e.g. Mother, Father,Aunt)(Please circlethe ingle/Married/Divorced/Widowed(e.g. Mother, Father, Aunt)(Please circle the appropriate option)(e.g. Mother, Father, Aunt)(Please circle the appropriate option)Occupation:ID / Passport No:Occupation:ID / Passport No:Occupation:ID/ PassportNo:HomeAddressHome AddressHomeStreet AddressName & No:Suburb / Township / Village:Street Name & No:Suburb / Township / Village:Street Name & No:Suburb / Township / Country:Postal Code:Country:Postal Code:Country:Postal Code:E-mail address:WHEREDID YOUWHEREHEARDIDABOUTYOUWHEREHEARUS? DIDABOUTYOU HEARUS?WHEREABOUTDIDUS?YOU HEARWHEREABOUTDID YOUUS? Pleasephone:tick the informationthe box(es)providedany tickandprovidedtheprovidebox(es)in phone:Cell:! AllanGray Orbis! FoundationAllan GrayWebsiteOrbis!FoundationAllan GrayWebsiteOrbisFoundation! AllanWebsiteGray Orbis Foundation! AllanWebsiteGray Orbis Foundation WeHomephone:Cell:Workphone:Fax:! Twitter! Twitter! Twitter! Twitter! TwitterWorkphone:Fax:Workphone:Fax:! SMS method of!contact:SMS Post / Email! / HomeSMS phone / Work phone! / CellSMS(Please circle the appropriate! SMSPreferredoption)Preferredmethod of!contact:Post / Email/ Homephone / Work phone/ Cell(Please circle the appropriate kphone/Cell(PleasecircletheappropriateCombined monthly household income of parent(s) and / or guardian(s) before deductions: (Please tick theoption)relevant box)Combinedmonthly householdincomeof parent(s)and / 199or guardian(s)deductions:(Pleasethe relevant box)! R0Youtube! R4YoutubeYoutube! beforeYoutube! tick Youtube– R4 799800 – R9 DETAILS599 ! R9600– R19R19200 – R38R38 400PARENTORGUARDIAN(2)(Information about yourparentor 399legal guardian)– R4 (I799800 –(IwithR9599600 –(IR19199R19200–details)R38399 an emailR38 the400! R0Emailreceived! threceivedthe details)an email! withEmailthe(Ireceived! Emailwith(I receiveddetails) an email omAllan Gray LtdTitle: Mr / Mrs / Ms / Dr (Please circle the appropriate option)First name(s):! Allan Gray Orbis! FoundationAllan GrayE-ZineOrbis!FoundationAllan GrayE-ZineOrbis Foundation! AllanE-ZineGray Orbis Foundation! AllanE-ZineGray Orbis Foundation E-ZAllan Gray Orbis Foundation Fellowship application form 2014 Learners currently in Grade 12Page 4 of 18! The Bursary Register! The Bursary Register! The Bursary Register ! TheBursary Register! The Bursary RegisterSurname:Date of birth: D D M M Y Y Y Y! School fySchoolwhichTeacherschool)(please! specifySchoolwhichTeacherschool)(please specifyCountryof citizenship:Parent/!Guardian(Pleasecirclethe appropriateoption)! An AllanGray Fellow! AntoldAllanmeGrayaboutFellow!it GrayFellow!told meAn AllanaboutGrayit Fellow told me ab

4. ACADEMICACADEMIC HISTORYHISTORY (Please(Pleaseensure that a certified copy of your school resultsincluded with aseensure MICHISTORY:School4. ACADEMIC HISTORY (Please ensurethat a certified copy of your school results is included with your ERE DID YOU HEAR ABOUTUS?WHERE DID YOU HEAR ABOUTUS?WHERE DID YOU US?DIDYOUHEARABOUTUS?DIDYOUHEAPleasename:tick DIDthe box(es)thatapplyABOUTand provideanyPleasespecifictickinformationthe anyWHEREPleasespecifictickinformationthe ERESchool oundation Website! Allan! AllanGrayOrbisGrayOrbis FoundationWebsite!specificAllanGrayOrbis yandprovideanyPleasespecifictickinformationthe box(es)inthatthe ormationthe box(es)inthatthe saStreetName:City:! ite!AllanGrayOrbisFoundaStr

application form in good time in order to meet the application deadline. Application forms received after 30 April 2014 (12H00) will NOT be considered. Please retain a copy of your completed application form and other relevant documents for your own records. Allan Gray Orbis Foundation contact details: Tel: 086 123 9235

Related Documents:

With reference to extramural fellowship (SRF/RA) proposals invited under ICMR Extramural Fellowship Proposals Scheme during the cycle 01.01.2020 to 31.01.2020. Total 815 Fellowship (SRF/RA) proposals are Technically Approved as per the list enclosed. The codal documents of technically approved SRF/ RA fellowship can be

Rhodes University, University of the Western Cape, Stellenbosch University and University of Pretoria Academic Requirements: . application form in good time in order to meet the application deadline. . Allan Gray Orbis Foundation Fellowship application form 201 Learners currently in Grade 12 Page 5 of 16

Your CSA application packet includes: these application instructions (Form 716), an identification form (Form 707) and the four-page application form (Form 706). You may use the following application form to apply for CSA administrations in 2001. APPLICATION MATERIALS FORM 716-W, Rev. July 2000 Page 1 of 4 IDENTIFICATION FORM

the SAPh graduate program: SAPh Alumni Fellowship (new 2014) St Peter & Leiner Family Fellowship Wertheimer Leadership Fellowship Donations to these Fellowship Funds are welcome. Please make your . rian J. Isetts received the Hubert H. Humphrey Award that recognizes APhA members who have made major contributions in government and legislative --

F.200 - SF 424 (R&R) Form 18 F.220 - R&R Other Project Information Form 33 F.230 - Project/Performance Site Location(s) Form 43 F.240 - R&R Senior/Key Person Profile (Expanded) Form 48 F.430 - PHS Fellowship Supplemental Form 60 F.500 - PHS Human Subjects and Clinical Trials Information 84 F.600 - PHS Assignment Request Form 121 Form .

Bhuj Mercantile Co-op. Bank RTGS Form . 12 BOB RTGS Form . 13 BOI RTGS Form . 14 CANARA BANK RTGS Form. 15 CBI RTGS Form . Federal Bank Second Page RTGS From . 20 HDFC RTGS Form. 21 HSBC RTGS Form. 22 ICICI Bank RTGS Form. 23 IDBI Bank RTGS Form. 24 IDFC First Bank RTGS Form. 25 Indian Overseas Bank RTGS Form . 26 INDUSLND Bank RTGS Form . 27 .

HARVARD UNIVERSITY South Africa Fellowship Program Application GUIDELINES AND APPLICATION PROCEDURES ELIGIBILITY The Harvard South Africa Fellowship Program (HSAFP) is intended for South Africans who were educationally disadvantaged by law and resource allocation under apartheid. In 1979, Harvard University began awarding these

7 Annual Book of ASTM Standards, Vol 14.02. 8 Discontinued 1996; see 1995 Annual Book of ASTM Standards, Vol 03.05. 9 Annual Book of ASTM Standards, Vol 03.03. 10 Available from American National Standards Institute, 11 West 42nd St., 13th Floor, New York, NY 10036. 11 Available from General Service Administration, Washington, DC 20405. 12 Available from Standardization Documents Order Desk .