CASA BURSARY APPLICATION

CASA BURSARY APPLICATION
Please read the following carefully:

1. The information supplied in this application form is used for consideration of the bursary, not all information supplied is a pre-requisite unless indicated. The entire person, being the applicant, is considered during the approval process.

2. Applications open on 1st September. Closing date for submissions is 30th September.

3. The Bursary is available to South African citizens only.

4. Applicants must be in their 4th , 5th or 6th year of study in a chiropractic program at DUT or UJ.

5. Applicants must be a CASA student member to be considered.

6. If you would like to apply for this bursary please complete the application form and upload the requested supporting documentation. Each file should be less than 5 MB, besides the video which can be up to 1GB zip filed.

7. It's essential to carefully review the specific requirements and instructions provided below and ensure that all requested information and documentation is included in the application.

8. Incomplete applications will not be considered. Applicants should also adhere to any deadlines and submission guidelnes outlined in the application process.

Personal Information
Upload a photo of yourself

Cancelof
Take a photo of yourself
Full Name (as in ID)*

First NameLast Name
ID Number*
Applicants cell number*
Please enter a valid phone number.
Gender*
Race*
Email address*
example@example.com
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*

Education Information
Current Institution*

Durban University of TechnologyUniversity of Johannesburg
Student Number*
Expected date of Graduation*
First Year of Registration*
Current Year of Study*
Include any awards, honors, or achievements:
Include any relevant work experience or internships:

Family Information
Number of Family Members Living in the Same Household*
1) Mother's Name and Surname (as in ID)*

First NameLast Name
Mother is:*
Mother's ID/Passport Number*
Mother’s email address*
example@example.com
Mother's Cell Number*
Please enter a valid phone number.
Mother's Occupation*
Mother's Gross Monthly Income*
Mother's Residential Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
2) Father's Name and Surname (as in ID)*

First NameLast Name
Father is:*
Father's ID/Passport Number*
Father's email address*
example@example.com
Father's Cell Number*
Please enter a valid phone number.
Father's Occupation*
Father's Gross Monthly Income*
Father's Residential Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
3. Number of siblings*
Siblings Ages
Number of dependants*
Family members who rely on you, the applicant, for financial support.

Financial Information
How are you currently paying for your tuition?*
Are you currently employed?*

YesNo
Occupation and Employer*
Gross Monthly Income (in Rands)*
Are you receiving other sources of income/financial aid?*

YesNo
If yes, in what form?*
Previous application of support and outcome thereof?*

Data Protection Notice
Please be advised that by submitting your application for the CASA Bursary, you acknowledge and consent to the collection, processing, and storage of your personal information in accordance with the Protection of Personal Information Act (POPI) and other relevant data protection regulations.
The information provided in your application will be used solely for the purpose of assessing your eligibility for the bursary and administering the selection process. Your personal data will be treated with the utmost confidentiality and will only be accessed by CASA Council members involved in the bursary selection process.
By participating, you understand that your personal information may be shared with third-party service providers strictly for the purpose of facilitating the administration of the bursary program.
CASA is committed to safeguarding your privacy and ensuring compliance with data protection laws.
Should you have any questions or concerns regarding the handling of your personal information, please
contact Dr Bridget Bromfield at sg@casacouncil.co.za .

1. Please note that only PDF format is accepted.
2. Ensure that you have scanned/clear photo copies of the required documents as per the document checklist below.
3. Please scan each relevant document as 1 file and name the file as the following:
"(Documents Type)_(Your name)".
For example, for Identification Documents, please scan as a single pdf and save the file as "Identification Documents_Siti".
4. Each file should be less than 5 MB.

NOTE: Incomplete submissions with incomplete/missing documentation will NOT be processed. We do NOT accept hardcopy submissions.

Document Checklist
Document Upload
1. Full Academic Record*

Cancelof
2. Letter from institution indicating registration*

Cancelof
3a. Reference One*

Cancelof
3b. Reference Two*

Cancelof
4. 1 page Biosketch*

Cancelof
5. I choose*

An interviewSubmission of a short 15 min video presentation on “Why me”.
5. Video Submission*

Cancelof

Date Time
Should be Empty:

CASA BURSARY APPLICATION

Personal Information

Education Information

Family Information

Financial Information

Document Upload