B. PERSONAL & ACADEMIC INFORMATION
1.
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Surname:
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complete
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Title:
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..
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Full names:
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..
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2.
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ID/Passport nr:
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..
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3.
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Student nr:
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..
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4.
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Country of origin:
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..
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5.
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Permanent address (residential):
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..
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..
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6.
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Are you currently employed? If so, in what capacity?:
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..
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7.
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Church affiliation or Organisation for which you work :
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..
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8.
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Address of the headquarters of your Church/Organisataion:
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..
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..
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9.
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Academic year: 20..
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..
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10.
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Degree for which registered:
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..
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11.
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What year of registration for this degree – refer point 10 (eg 1st/2nd/3rd):
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..
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12.
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Name of your promotor/study leader:
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..
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13.
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Expected duration of studies at Stellenbosch to complete this degree:
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..
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14.
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Are you planning to reside full-time in Stellenbosch ? (Yes/No):
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..
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15.
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Address Stellenbosch (residential):
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..
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..
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Tel/Cell:
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..
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email:
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..
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16.
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If married, will you be coming alone of be accompanied by your family?
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..
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17.
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If your family are to accompany you, please indicate the number of children who are to come and their ages:
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..
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C. FINANCIAL DETAILS
Currency – used to complete amounts below:
R (SA Rand) / $ (US Dollar) / Home currency?
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..
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INCOME for this year
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AMOUNT
in specified currency
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Expected financial EXPENDITURE for this year
directly related to your studies is Stellenbosch (if known)
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AMOUNT
in specified currency
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1. Bursaries from University of
Stellenbosch (specify)
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1. Study permit
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2. Salary/stipend from your
employer
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2. Registration and class fees
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3. Financial assistance from your
church/organisation
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3. Books
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4. Financial assistance from the
Mission Office of the DRC
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4. Typing of thesis
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5. Assistance from other sources
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5. Accommodation
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6. Personal/family expences
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7. Medical expences
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8. Travel Expences
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9. Other (specify):
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TOTAL
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TOTAL
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I the undersigned, declare that all information given on this form is complete and correct.
Student SIGNATURE
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x
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DATE:
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..
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D. RECOMMENDATION BY STUDY LEADER/PROMOTOR:
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..
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..
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..
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..
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..
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Promotor/Study Leader SIGNATURE
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x
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DATE:
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..
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Please send the completed form to one of the following offices before the due date:
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DR Church Seminary [details at the top/beginning of this form]
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DR Church in SA Synodal office [details below]
ENQUIRIES: Ingrid van Eck (Accountant: Salaries & Study Loans), DR Church in SA Synodal Office
5 De Lange Street, Bellville, 7530, South Africa | Private Bag X8, Bellville, 7535, South Africa
Tel: 021-957-7107/4 | Fax: 086-647-1188 | email: ivaneck@kaapkerk.co.za
