APPLICATION FORM INSTRUCTIONS

2015 UJ-CSIR SCHOLARSHIPS APPLICATION FORM
Please read through the instructions carefully before submitting an application.
INSTRUCTIONS
Application forms can be completed online on a word document provided and be submitted together
with the requested documents as indicated on the checklist.
1. Applicants must read through the Programme Guide carefully BEFORE submitting an application.
2. All fields in the application form must be completed correctly or your application will be rejected.
3. All applicants must submit the following documents:
•
•
•
•
An application form;
Curriculum Vitae (clearly indicating your study field);
ID document;
Full official academic record including all levels of tertiary study prior to your current qualification.
Please note that academic records from student portals will NOT be accepted. (Do not submit
certificates. Academic records must include marks);
• For Master’s and Doctoral students – a brief (max one page) outline of the project you would like
to explore (clearly indicating the research area – as specified in Section 3 that you fit into); AND
• Letters of reference (see table below for specific letters of reference required per level of study)
Level of study in 2012
Referee reports required
Honours
Two referees (at least one academic lecturer or HOD)
1st year Master’s
Two referees (at least one academic lecturer or HOD) and potential supervisor
(if already identified).
2nd year Master’s
Supervisor of Master’s and two referees (at least one academic lecturer or HOD)
Doctoral
Supervisor of Master’s; HOD of Master’s and one other referee
(preferably an academic lecturer)
4. All applications should be emailed together with the required documents to Ms Dudu Mbatha: [email protected]
CLOSING DATE: 31 October 2014 (all posted and couriered applications must reach us by the
deadline or they will be rejected).
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2015 UJ-CSIR SCHOLARSHIPS
APPLICATION FORM
PARTICULARS OF APPLICANT
Title
Surname
First names (in full)
Date of birth
(YYMMDD)
Maiden name
ID number
Nationality (NB: You must
be South African to apply)
Male
Do you have a disability? (Y/N)
If yes, please specify
Race
If you are a UJ student, indicate
your student number
University where you were registered
for your previous degree
Level of study in 2015
Honours
Master’s
Telephone number during the
day (code and number)
Cellphone
Number
Other contactable numbers
Email address (Please indicate clearly as all correspondence will take place via e-mail)
Title
(For Master’s and Doctoral students) If you have made
contact with The University of Johannesburg, please
indicate the potential/current supervisor at the institution
Initials
Surname Faculty (to be completed by all applicants)
(Should you be in doubt, please contact the relevant
faculty contact as indicated in the table below to
ascertain the relevant faculty)
Research Area/Department
(eg. Chemistry, Electrical Engineering)
(to be completed by all applicants)
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Doctoral
Female
EXISTING COLLABORATION WITH CSIR
For Honours Applicants: to be completed by HOD.
Is the student’s proposed study a part of an existing
collaboration with CSIR?
Details of HOD:
Title
If yes, indicate the CSIR Representative involved in the
collaboration.
Initials
Surname
Email address
For Master’s and PhD Applicants: to be completed by a
Supervisor or proposed Supervisor.
Is the student’s proposed study a part of an existing
collaboration with CSIR?
Details of Supervisor:
Title
If yes, indicate the CSIR Representative involved in the
collaboration.
Initials
Surname
Email address
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2015 UJ-CSIR SCHOLARSHIPS
CONSENT and DECLARATION
1. I do hereby give my unqualified consent to the Council for Scientific and Industrial Research
jointly with the University of Johannesburg (herein referred to as UJ-CSIR) to make whatsoever
enquiries they deem fit about me in connection with my suitability to be awarded a scholarship
for which I have applied.
2. I have read and I am familiar with eligibility requirements as indicated in the 2015 UJ-CSIR
Scholarship Programme Guide.
3. I accept that the decision of the UJ-CSIR selection committee with regard to my application will
be final.
4. I grant permission to UJ and CSIR to jointly have access to information pertaining to my
biographical information and academic achievement.
5. I declare that any misrepresentation of the facts in this application by false declaration, omission of
information or both will entitle the UJ-CSIR to summarily terminate my scholarship.
6. I further declare that I will inform UJ-CSIR should I receive full-time salaried employment during the
tenure of the scholarship if I am successful.
Signed on the ____________________ day of ____________________________________________ 2014
at ______________________________________________________________________________________
Applicant’s signature ______________________________________________________________________
CHECKLIST OF DOCUMENTS TO BE SUBMITTED FOR UJ-CSIR SCHOLARSHIP PROGRAMME
Documents
Submitted
Not
submitted
An application form
Curriculum Vitae (clearly indicating
your study field)
ID document
Full official academic record
including all levels of tertiary study
prior to your current qualification
For Master’s and Doctoral students –
A brief (max one page) outline of the
project you would like to explore
Letters of Reference Work
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Comments, if not submitted
2015 UJ-CSIR SCHOLARSHIPS
AGREEMENT
UJ-CSIR SCHOLARSHIP FOR HONOURS, MASTER’S
AND DOCTORAL STUDY
I, _____________________________________________________________________________ (full name);
Student number___________________________ and ID number: _______________________________
(hereinafter the scholarship-holder), hereby accept the scholarship awarded to me by the University
of Johannesburg (hereinafter the UJ) for purposes of my further studies as follows: The terms and
conditions as may be imposed by the UJ and of which the scholarship-holder shall be advised in writing
shall form an integral part of this agreement. The scholarship is awarded subject to the following terms:
SCHOLARSHIP CONDITIONS
1. The scholarship-holder will be and remain a registered UJ student during the tenure of the scholarship at the UJ.
2. The scholarship will be awarded maximally for the prescribed period only, viz. two years for Master’s study and three years
for Doctoral study.
3. If a scholarship-holder does not obtain the degree for which the scholarship was awarded within the prescribed period
(three years for Master’s and five years for doctoral study); relinquishes his/her studies, or leaves the UJ during the period
for which the scholarship was awarded, the UJ may at its sole discretion require him/her to refund all payments of the
scholarship already received for study towards the particular degree/diploma, plus interest at the rate of 15,5 % per annum
a tempore morae.
4. Should the scholarship-holder fail to fulfil any material condition of this Agreement or should it transpire that a scholarship
was awarded on the basis of false information supplied to the UJ, the UJ would be entitled to cancel this agreement and
recover any bursaries paid together with interest calculated on the same basis as envisaged by clause 3 above.
Notwithstanding the conditions referred to in the clauses of this agreement, the UJ reserves the right to adjust or
cancel its scholarship in consultation with the Student.
5. The scholarship-holder will notify the UJ immediately of any change in the circumstances under which the scholarship was
awarded that might adversely affect the award of the scholarship and will in any event not take up another scholarship from
a third party/institution without the UJ’s prior written consent. Should the scholarship-holder fail to do this, the UJ, may at
its sole discretion, and with immediate effect, cancel the scholarship, in which event the scholarship-holder will be liable to
refund the scholarship as contemplated in Clause 3 above.
6. Should the scholarship-holder be in material breach of the terms and conditions of this agreement and the UJ be compelled
to institute legal action for the recovery of the scholarship or any portion thereof, the scholarship-holder will be liable for all
costs incurred on the scale as between attorney-and-client and further agrees to the jurisdiction of the Magistrate’s Court in
accordance with Section 45 of Act 32 of 1944, as amended, for any action that may arise from this agreement.
7. The scholarship-holder hereby elects the following residential address as his/her domicilium citandi et executandi for the
service of all notices or court process in terms of this Agreement:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
(NB: PO Box numbers and university residence or departmental addresses are not acceptable. Please provide a
residential address.) The Student shall notify the UJ, in writing, of any change to his/her residential address so chosen as
his/her domicilium citandi et executandi. In the event that the UJ has to appoint tracers to establish the current whereabouts
of the Student, in order to enforce its rights in terms of this Agreement, the UJ shall be entitled – in addition to the costs
referred to in clause 6 above – to also recover the costs of such tracers from the Student.
8. No alteration, amendment, consensual cancellation or addition to this agreement shall be valid unless they are reduced to
writing and signed by both parties.
Accepted and signed at ____________________________________ this ______ day of _____________________ 20_______
___________________________________________________
___________________________________________________
Scholarship-holder’s signature
Scholarship-holder’s identity number
___________________________________________________
___________________________________________________
1. Witness’ signature
1. Witness’ identity number
___________________________________________________
___________________________________________________
2. Witness’ signature
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2. Witness’ identity number
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