Enclosure 1

Research Office

CLAUDE HARRIS LEON HONOURS BURSARY

APPLICATION FORM FOR 2011

Please read the accompanying information sheet.

The following document must accompany this application:

 detailed academic record of the student from the beginning of his/her tertiary education career, i e
course marks are required

Incomplete applications will not be considered.

Please complete this form in typescript

Completed applications must be returned to the Research Office, Room 10005, 10th Floor, Senate House
not later than 5:00 pm on Friday 21 January 2011.

This form and the information sheet may be downloaded as MSWord files from
http://web.wits.ac.za/Academic/Research/General+information+for+Researchers/Applications.htm

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A PARTICULARS OF APPLICANT

Surname: ___________________________________________________________ Title: ___________

First Names: _________________________________________ Student No: _____________________

Date of birth: _____________________________ Nationality: _________________________________

Degree for which you intend to be registered in 2011: _________________________________________

School:______________________________________ Faculty: ________________________________

Date of actual or intended first registration for the above degree: ______________________________

Anticipated date of completion: _____________________________

Assuming successful completion of an Honours degree, what is your intention thereafter? eg to seek
permanent employment, to register for further study (Masters, PhD, etc), to travel abroad, etc

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Please give your reasons for applying for this bursary

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What career to you intend to pursue when you leave University and why?

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Any other relevant information you wish to bring to the attention of the persons assessing this application

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STATEMENT BY STUDENT:

I certify that (a) I have read the Information Sheet on the CH Leon Honours Bursary Programme, that (b)
the information supplied in this application is correct, and that (c) if I am selected to participate in the CH
Leon Honours Bursary Programme, I will abide by the rules of the Programme.

Signature: ________________________________________________ Date: _____________________

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B RECOMMENDATION BY THE HONOURS COURSE CO-ORDINATOR OR HEAD OF SCHOOL

To be returned directly to the Research Office (please see front page)

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Name: __________________________________ School: _____________________________________

Signature: _______________________________ Date: _______________________________________

MSWord/Iain0005/LeonHonsAppFm.wps