Applications must be sent to:
Tel: 011-208 4205
Application form for an Accenture (SA) Education Trust Scholarship
Toundertake 2nd to 4th year/Honours of full-time study
At a tertiary institution in 2018
Important –
- Please complete this form.
- Mark appropriate blocks with an “X”.
- If a question is not applicable, put N/A.
- Failure to complete this application form fully andcorrectly may prejudice the applicant’s chances of obtaining a scholarship.
1. Surname:
2. First names: / 3. Title (Mr/Ms):
4. ID number: / 5. Date of birth: / //
dd / mm / yyyy
A certified copy of your ID document must be attached to the completed application form.
6. Your contact details:
Permanent residential address:
Postal code: / Postal address:
Postal code:
Cell phone number: / Email address:
7. Next of kin:
Name: / Contact number:
8. Are you a South African citizen? / Yes / No / 9. Gender: / Female / Male
10. Race: / African / Coloured / Indian / White
(For statistical purposes only)
11. School information:
Name of secondary school / Town / Province
12. The university at which you are currently enrolled:
University of Cape Town
University of the Western Cape
Rhodes University
/ University of Pretoria
University of Johannesburg
University of the Witwatersrand
13. Name of your degree course:
Computer Science
Informatics/ Information Systems
Information Technology
Computer Engineering
/ Electrical Engineering (Light Current)
Electronic Engineering
Information Engineering
Industrial Engineering
14. Current year of study:
Foundation/General Entry Programme/Extended Curriculum/ASPECT Programme:
Year 1
Year 2
First year
Second year
Third year
/ Other – please explain:
15. Student no.:
16. Please list your first and second semester courses in 2017:
1st semester / 2nd semester
- A certified copy of your academic transcripts, together with a copy of your 2017 mid-year exam results, must be attached to this form.
- If you are in your first year of study, please attach a copy of your matric results.
- If you did not write mid-year exams, please obtain a progress report from your faculty.
17. Accommodation:
Are you in a university residence? Yes No
If the answer to the above is no, where are you currently staying?
18. How are you currently financing your studies?
If you have a bursary, are there any obligations to the funder of the bursary after you graduate?
19. Where did you find out about this scholarship?
Friend/fellow student
Career exhibition
University lecturer/bursaries office/email
Accenture website
/ Internet – if so which website:
Other – please specify:
20. Describe in approximately 200 words how the qualification you are seeking will benefit society in South Africa.
21. Have you applied for an Accenture (SA) Education Trust scholarship previously?If so, when?
22. This section must be completed by your parents or guardian.
A key requirement of the Trust Deed is that recipients of a scholarship are in significant financial need and would not otherwise be able to attend university without the support of a scholarship. The trustees need certain personal information to ensure that recipients meet this criterion. Such information will remain confidential.
22.1 FATHER: / Occupation: / Monthly income:
22.2 MOTHER: / Occupation: / Monthly income:
22.3 GUARDIAN: / Occupation: / Monthly income:
22.4 OTHER SOURCES OF INCOME
- Proof of earnings: a certified copy of your parents’/guardian’s income tax return. If this cannot be provided, a certified copy of your parents’/guardian’s monthly payslips (if applicable) OR a letter from their employers verifying their income AND/OR a certified copy of any other income e.g. pension receipts, bank statements, etc.
- If either parent is deceased, a certified copy of the death certificate must be provided.
23. Supporting documents
23.1 Certified copy of identity document
23.2 Certified copies of academic transcripts
23.3 Certified copy of 2017 mid-year exam results/progress report
23.4 Certified copy of proof of parents’/guardian’s earnings
23.5 Copy of your curriculum vitae
24. Declaration that the above particulars are complete and correct:
……………………………………………………………………..…………......
Signature of applicant
………………………………………………………………………………………
Signature of parent/guardian / Date
Date