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Gillooly’s View Office Park, 1 Osborne Lane, Bedfordview, 2007, PO Box 1964, Bedfordview 2008
Telephone: 011-456-8579; Fax: 011-450-4948; Email [email protected]; Website: http://www.lgseta.org.za
Bursaries Learner Registration Form for Unemployed Individual
Print the form and Sign and initial (on every page)
Section A: Particulars Learner
Surname: Maiden surname (if applicable):
First name: Title (Mr. Mrs. Ms.): Mr
Date of birth: Identity Document number:
Race: African / Black Disability: N/A
Gender: Citizenship: South African
Physical address
Postal address
Province:
Municipality:
Learner Residential Area:
Tel number Fax number:
Cell number
Email address
Highest level qualification completed:
(Highest level school qualification completed e.g. grade 10 ,11,12):
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Section B: Particulars of Next of Kin
Surname: First name: Revelation Title:
Relationship: Tel number: Cell number:
Address:
Section C: Particulars of Study
Institution Name: Campus:
Student Number: Name of Qualification:
Qualification ID number: NQF level:
Specialisation: Year of studies (e.g. 1st year,2nd year):
Start Date: End Date:
Bursary amount (Subject to Bursary Conditions)
Name of Institution
Institution Type HET, Public
Physical address
Tel number Fax number:
Email address
Learner Declaration
(Please note that the guardian signature is required if the learner is under 18 years)
1. I declare to the best of my knowledge that all information on this form is true and correct and I understand that if it is not, I
may be eliminated from consideration in the selection process. If after being granted a bursary, any falsehoods or omissions
are discovered in my application, I understand that my bursary grant may be terminated.
2. I undertake to avail myself for participation in all structured learning, practical workplace experience and assessment
activities required by the bursary scheme.
3. I Authorisation the LGSETA to deal directly with the Institute on my behalf and receive copies of my progress reports
quarterly and results.
Name and Surname of learner
Signature of learner : Date:
(Only applicable if the learner is a minor)
Name and Surname of parent or guardian
Parent of guardian’s signature: Date:
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NOTES AND INSTRUCTIONS FOR COMPLETION
Read these notes carefully before completing the application form. Make sure that you read
every section and that the information you provide is accurate.
1. INCOMPLETE FORMS WILL NOT BE ACCEPTED (this includes forms with missing
documents)
2. The LGSETA does not take responsibility and will not be held liable for any forms which
were undelivered or missing.
3. Students who are granted a bursary from another organization/institution are obliged to
inform the LGSETA. The LGSETA have the right to withdraw funding awarded if the
student receives a bursary elsewhere.
4. A bursary is awarded for one year only and students are required to apply annually to
the LGSETA for a bursary.
5. Non-South African students will not be considered.
6. Employed Learners will not be considered.
7. A senior student must have passed the previous year’s studies to qualify for an LGSETA
bursary;
8. The students must meet the entry requirements for the programme as required by the
HET or TVET Institution.
9. The qualification must be accredited on the NQF/N Levels.
