Passport Photo
Roots Bursary Scheme
APPLICATION FORM FOR BURSARY
CLOSING DATE FOR APPLICATIONS: 8 December 2023
Please return the application form to (preferably, electronically):
Electronic application: Hardcopy application:
Please send email to: Anthea van Heerden
roots@[Link] Namib Mills (Pty) Ltd.
Dortmund Street
Northern Industrial
Windhoek
If you have not received feedback or correspondence relating to this application from Roots by 15
February 2024, you can assume that your application has been unsuccessful.
SECTION A – APPLICATION DETAILS
(Please complete clearly)
1. Field of study (as advertised)
1.1. Undergraduate bursary (please select one):
☐ Artisan trade: Millwright
☐ Artisan trade: Mechatronic Technician
1
SECTION B – PERSONAL PARTICULARS
(Please complete clearly)
First name(s):
Surname:
Postal address:
Residential address:
Contact number:
Email address:
Citizenship:
Date of birth:
ID or Passport number:
Gender:
Marital status:
Home language:
Second language:
State of health:
Particulars of parent / guardian:
Nature of relationship (e.g. mother, aunt,
guardian, etc.):
First name & Surname:
Postal address:
Residential address:
Contact number:
Email address:
Occupation:
Name & Address of employer:
2
Number of dependents: SECTION C – CAREER & EDUCATION
(Please complete clearly)
Secondary education:
Name of High School and town:
Year-end or last examination date:
Grade 12 subject results:
Subjects: Results (%):
1. Subject:
2. Subject:
3. Subject:
4. Subject:
5. Subject:
6. Subject:
7. Subject:
8. Subject:
Overall average
percentage (%):
Career ambitions & tertiary education:
State the career you wish to follow:
Have you already obtained a previous tertiary
qualification? If so, kindly state the name:
Name of the qualification you are studying or
intend to study:
List your major subjects:
Do you have to repeat any subjects? Which
ones?
Academic study year for which you will be
registered in 2024 (e.g., first year, second year,
third year, etc.):
Name of tertiary institution where you are
enrolled or going to enrol:
Duration of the course (e.g., 3 years)
Where are you going to stay or do you stay
when studying?
3
What are your future plans or dreams? What
type of work would you like to do?
Would you like to study further after
completing this qualification?
Have you gain any work experience? If so,
please elaborate
(Please ensure that you have attached your academic record)
Other bursaries or scholarships attained or applied for:
Name of Donor: Amount: Granted (yes/no): Obligations:
1. Tell us about yourself (not any information provided in above-mentioned answers)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
COMPULSORY DOCUMENTS TO ACCOMPANY YOUR APPLICATION:
• Certified copy of your Grade 12 results
• Submit copy of your latest results (tertiary institution)
• Passport photograph
• Certified copy of at least one (1) testimonial
• Certified copy of birth certificate / passport
• Proof of provisional acceptance or registration at tertiary institution
• Quote or estimate of costs of studies
• Motivation letter from applicant
• Comprehensive resume
• A copy of the relevant contract of any other funding for your education
FAILURE TO COMPLETE THE APPLICATION FROM TRUTHFULLY, MAY LEAD TO THE WITHDRAWAL OF
THE BURSARY.
4
Undertaking:
I (full name and surname), ________________________________________, (ID number)
________________________ hereby declare that the information supplied by me are correct to the
best of my knowledge.
Signed on this day (date) __________________________ at (place) __________________________.
_________________________________ _________________________________
Signature of Applicant Name & Surname of Applicant
