WINDHOEK GOREANGAB OPERATING COMPANY

APPLICATION FORM: UNDERGRADUATE BURSARY 2006

Mr._____ Miss.______

Name: _____________________________________

Degree: ____________________________________

Academic Institution: _________________________________

Field of Study: ______________________________ (Water related)

Degree/Diploma: ______________________________

Signature: __________________________________

Date: ______________________________________

BEFORE COMPLETING THIS FORM, PLEASE NOTE:

• Answer all questions
• Duplicates and in some cases certified copies of certificates/results must be attached.
• All information will be treated as highly confidential.
• Completed forms together with a recent passport photo of yourself must be sent to:

The General Manager

Windhoek Goreangab Operating Company (Pty) Ltd

PO Box 2103

Windhoek

Namibia

Tel: (061) 272138/272083

Fax: (061) 272263

Matshitshi Road, Goreangab Ext. 3, Windhoek

Incomplete application forms will not be processed. Please complete the application form carefully to ensure that the right information is given. No late applications will be accepted.

Closing date for applications: Friday, 17 November 2005

1. PARTICULARS OF APPLICANT

Surname: _____________________________________

First Names: ___________________________________ Popularly known as: ______________

Home Address: ____________________________________________________________________

Postal Address: ____________________________________________________________________

E-Mail Address: ____________________________________________________________________

Telephone Numbers where you can be contacted: _________________________________________

Date of Birth: __________________________________ Identity Number: ______________

Citizenship: ___________________________________ Place of Birth: ________________

Home Language: _______________________________ Other Languages: _____________

Marital Status: __________________________________ Number of Children: __________________

Present Status: (Please mark appropriate box with a tick)

Scholar

Student

Employee

Other (specify)

Name of parents or guardian if minor: ____________________________________________________

Address of parents or guardian: _________________________________________________________

Contact Details of parents or guardian: ___________________________________________________

Occupation of parents or guardian: ______________________________________________________

Give particulars of disabilities or any illness you are suffering from: _____________________________

2. interests

· Hobbies: __________________________________________________________________

· Reading Matter: ____________________________________________________________

Extramural activities eg. Chess, tennis, etc.

Activity

Team

Comments

3. academic records

3.1 School Progress

Name of School:_____________________________________________________________________

			Agricultural
Academic	Technical	Commercial

Type of School:

Subjects Passed:

Grade 10

Year Passed: _________

Subjects:

HIGCSE:

IGCSE:

Results:

Grade 11

Year Passed: _________

Subjects:

Higcse:

Igcse:

Results:

Grade 12

Year Passed: _________

Midyear results if not passed yet.

Subjects:

Higcse:

Igcse:

Results:

4. intended study details

4.1 Intended field of study: _______________________________

At which Academic Institution you prefer to study?_______________________________________________

Duration of Studies:____________________________________________________________________

Accommodation: Hostel __________ Private______________ (Please tick appropriate)

First Year of Study: ______________

Expected Year of Completion of Study: _____________________

First Year Subjects

Year

Results

Second Year Subjects

Year

Results