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New Under-Graduate ✔

NEW UNDERGRADUATE INTERNAL FINANCIAL SUPPORT APPLICATION FORM 2022/2023

Complete this application in full, incomplete applications will be disqualified and not be considered
A. PERSONAL DETAILS

NAME AND SURNAME MARILYN BOOYSEN

STAFF NUMBER 10027448
RACE COLOURED GENDER FEMALE DISABILITY YES NO

DESIGNATION EMERGENCY COMMUNICATOR T LEVEL 8

DIRECTORATE SAFETY AND SECURITY
DEPARTMENT FIRE AND RESCUE SERVICE
BRANCH / UNIT COMMAND AND CONTROL CENTRE
CELL PHONE NUMBER 0736531441
ALTERNATIVE E-MAIL not City
of Cape Town marilyn.booysen07@gmail.com
B. DETAILS OF PROPOSED STUDIES
8.1.30 Internal financial support shall not be awarded to employees who have incomplete studies/qualifications for which funding was provided by
the City.
8.1.33 The internal financial support beneficiaries are required to submit a certified copy of their qualification within three months of completion or
graduation. The City reserves the right to obtain the results from the institutions. Failure on the part of the beneficiary to submit their results, will result in
the qualification being deemed incomplete.

STATE YOUR HIGHEST COMPLETED QUALIFICATION

MATRIC * NQF Level 4
AND NQF LEVEL

WHAT YEAR DID YOU COMPLETE YOUR HIGHEST

QUALIFICATION ( ATTACH PROOF COMPLETION) 2005
DID THE CITY FUND ANY OF YOUR PREVIOUS
YES NO If Yes, What NQF Level NQF Level
STUDIES
8.1.14 The City will not approve applications for qualifications that are equivalent to the applicant’s current NQF level qualification which the City
previously funded. An equivalent or lower NQF Level qualification will only be approved if it is an occupational/job requirement, professional, critical
and scarce skills related qualification.
PROVIDE FULL NAME OF THE PROPOSED What NQF
QUALIFICATION AS SHOWN IN THE ADVERTISED LIST DIPLOMA IN HUMAN RESOURCE MANAGEMENT
(Certificate, Diploma, B-Tech or B Degree)
Level Band
1-10
5
Alignment Yes No

DOES THIS QUALIFICATION ALIGN WITH THE 1. Relevant qualifications linked to career streams priorities in the
FOLLOWING? (Please tick) city for 2022/2023 ✔
2. Approved Scarce Skills ✔

IS THIS YOUR FIRST UNDER GRADUATE

YES NO
QUALFICATION

FULL NAME OF EDUCATION INSTITUTION

(College, University of Technology, University)

ACADEMIC YEAR LEVEL OF QUALIFICATION 1st

✔ 2nd 3rd 4th
5TH or Above
insert level

DO YOU HAVE OUTSTANDING RESULTS? IF YES, SUPPLY THE REASON

* YES * NO

DO YOU REQUIRE BLOCK RELEASE FOR THIS

YES NO IF YES, FOR HOW LONG?
QUALIFICATION?
 NEW UNDERGRADUATE INTERNAL FINANCIAL SUPPORT APPLICATION FORM 2022/2023

C. COSTS
8.1.13 financial support will be limited to registration, tuition, examination fees and a study aid or capped study aid allowance. The study aid
allowance will be determined by the delegated authority.

TOTAL ESTIMATED COST FOR THE FULL QUALIFICATION

R 92 600.00
Meaning Full Certificate, Full Diploma, Full Degree)
ESTIMATED FEES FOR THE 2022/2023 ACADEMIC YEAR
R 32 580.00
ONLY

D. PROPOSED 2022/2023 ACADEMIC YEAR MODULES OR SUBJECTS (if on tender or bulk payment indicate grand total per student)
8.1.15 Employees are required not to register for more than four modules per semester or 8 modules per year. In the event of an institution requiring
more than four modules/subjects per semester, a letter from the institution must be submitted.

PROPOSED 2022/2023 ACADEMIC YEAR MODULES OR SUBJECTS ( Attach Quote)

Please take note of pre-requisites when selecting your semester courses
SEMESTER ONE SEMESTER TWO
COST COST
SUBJECT / MODULE FOR 2022/2023 SUBJECT / MODULE FOR 2022/2023

1. PUBLIC RELATION 1 R 3565.00 5. APPLIED PSYCHOLOGY R 3565.00

2. COMPUTER LITERACY ADVANCED R 4650.00 6. HUMAN RESOURCEMENT R 3235.00
3. FUNDAMENTALS OF ACCOUNTING R 3565.00 7. WORKPLACE PSYCHOLOGY R 4430.00
4. HUMAN RESOURCE DEVELOPMENT 1 R 4595.00 8. BUSINESS MANAGEMENT 1 R 4075.00
EXAMINATION / ASSESSMENT COSTS
( if applicable)
R REGISTRATION FEES R
650
REGISTRATION COST ( If applicable) R

TOTAL FEES FOR 2022/2023 R 32 580.00

NOTES TO APPLICANT
Please attach the following documents:

1. Quotation from the institution for proposed subjects / modules for the full qualification and or the year or Semester.
2. Latest available Audited Final Examination / Assessment results / Progress report by the Institution.
3. Letter specifying the reasons/s for the interruption in your studies in 2022/2023 (if applicable).

I hereby accept that on approval of my application / Request:

• I will ensure that I enrolled with an accredited institution of my choice offering an accredited qualification or program.
• I may not change the institution and qualification without approval process by all relevant delegated authorities.
• The city will withdraw financial support if I do not pass more than 50% of the modules / subjects registered for in a given academic / financial
year.
• I accept that I will be liable to pay fees or associated costs to register for the subject or modules that I have not passed.
• I will be liable for the full amount of the financial support which I obtained from the city if I withdraw from an academic program or
qualification for which I have received funding for.
• I will be subject to all conditions contained in the Education Training and development Framework.
• I will be responsible for submitting all invoices for payment to the Departmental ETD Representative/s.
• I will be responsible for submitting all examination results to the Departmental ETD Representative/s.
• The City may obtain my academic results directly from the institution.
• That all my repayments for modules not passed and or discontinued studies will be dealt with in accordance with the Education Training
and Development Framework.
• I will sign an annual contract that will emphasize the conditions of the support every academic year.
POPI Action Consent

Do you agree that your Information provided can be verified? Yes No

I hereby confirm that the information provided is a true reflection of my

Yes No
skills and qualifications and all other relate information

The City is committed to ensuring that your personal information is used appropriately, transparently and
in accordance with the Protection of Personal Information (POPI) Act.

* APPLICANT’S SIGNATURE: ________________________________

* DATE: _______________________

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 NEW UNDERGRADUATE INTERNAL FINANCIAL SUPPORT APPLICATION FORM 2022/2023

SUPPORT BY LINE MANAGER

(Operational requirements and or Service Delivery Implications considered)
8.1.35 The line managers shall appoint mentors for each individual employee who is a beneficiary of financial support. The mentor shall be accountable
for supporting the beneficiaries and monitoring their progress for the duration of their studies.
*SUPPORTED (Select yes or no)
YES NO

Linked to Not Linked to

Reason for Supporting / Not Supporting
Tick appropriate Block

1. Relevant qualifications linked to

1. Relevant qualifications linked to career
career streams priorities in the city for
streams priorities in the city for 2022/2023
2022/2023

2.. Approved Scarce Skills 2. Approved Scarce Skills

*SIGNATURE

*DATE

CHECKLIST

Items Yes No

1. Did you attach Proof of University Application? ✔

2. Did you attach the Quotation? ✔
3. Did you attach proof of highest last completed
qualification? ✔
4. Is this form completed in full? ✔
5. Is the certified ID copy attached?(not older than 3
months) ✔
FOR OFFICE USE

Signature of Corporate ETD Administrator

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