Fillable Private Bag X 17, Bellville 7535, South Africa, (North-West University)

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Private Bag X 17, Bellville 7535, South Africa, (North-West University)

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University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
APPLICATION FOR PROFESSIONAL PROGRAMME IN RESEARCH PSYCHOLOGY
Surname:
Date of Birth:
Name:
Age:
Telephone/ Cell:
Insert your photograph here:
Email:
Postal Address:
Name and telephone number of friend or relative that we can contact if we are unable to reach you:
Do you have a foreign qualification?
If Yes, is the qualification SAQA approved?
Indicate the nature of your foreign qualification?
◻ YES
◻ YES
◻ NO
◻ NO
Have you applied for a place in this course before? If so, at which university and which year/s did
you apply?
How are you planning to fund your studies, if selected?
DEPARTMENT OF PSYCHOLOGY
Private Bag X 17, Bellville 7535, South Africa, Telephone: (021) 959-2283/2453
Fax: (021) 959-3515, Telex: 52 6661, Email: mresearchuwc@gmail.com
University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
PERSONAL DETAILS
1
Race
◻
◻
Coloured
◻
Indian/Asian
◻
White
Gender
Nationality
Relationship Status:
Do you have any disability that may impact on your training?
◻
Yes
◻
No
If Yes, what is the nature of your disability:
What reasonable accommodation would you require if selected?
Do you have any dependent children?
Provide details (i.e. number of & age of children):
◻ Yes ◻ No
Do you have any dependent adults that require
care? Provide details:
◻
Yes
◻
No
Are you currently employed?
◻ Yes ◻ No
Medical history: Please indicate relevant conditions, incidents, etc.
Please indicate your proficiency in the following languages by using the ratings:
good/average/weak/none
Language
Understand
Speak
Write
English
isiXhosa
isiZulu
Afrikaans
Other South
African
Languages
1
In this case, race is used for purposes of training/employment equity (NB. The categorisation of people in different population
groups has been done in terms of the BEE Act, 53 of 2003).
University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
ACADEMIC DETAILS
UNDERGRADUATE PSYCHOLOGY RESULTS
Year
University
Average marks for psychology (calculate the
aggregated mark for your Psych 1, 2, and 3
credits)
%
Psychology 1 (Average of all Psychology 1
modules)
Psychology 2 (Average of all Psychology 2
modules)
Psychology 3 (Average of all Psychology 3
modules)
Psychology 4 (If you completed a B.Psych
Equivalent degree)
POSTGRADUATE PSYCHOLOGY RESULTS
What is the status of your Psychology Honours
Degree?
◻
Current
◻
Completed
Year:
If you are currently enrolled for Honours, indicate
at which University:
Year
University
Psychology Honours Modules
%
Overall Result (%)
List specific training/development in research
Year
Training (name and
specify level)
Institution
Passed %
University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
Research experience (specify the extent of the community focus)
Year
Organisation
Position
Duties
Please indicate any other Postgraduate qualifications that you have
Year
University
Course (e.g. MA, PHD, Post-graduate diploma)
Include in your application your full academic record detailing the other courses that you completed.
OCCUPATIONAL EXPERIENCE
Indicate your occupational experience and whether this was undertaken on a full time, part
time or voluntary basis
Year
Position/Type of work that you did
Part time, Full time or
Voluntary
Please indicate your motivation for choosing UWC
University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
Please indicate your research papers/conference presentations (if any)
APPLICANTS WITH FOREIGN NATIONAL STATUS
If you are foreign national, please provide the following
information
Yes/No
Have you obtained a foreign qualification? If yes, please specify
Has it been SAQA assessed?
Has it been SAQA approved?
Do you have SA permanent residency status?
Please specify the nature of your VISA? _____________
Indicate VISA expiry date:
Please submit relevant documentation
Details of 2 Referees
Referees name
Telephone & Email
Capacity
(In what capacity does this person know you?)
Note: You are required to send each of your referees the Confidential Referee Report Form. Your
referees must submit the referee report form prior to the closing date for applications (30
th
September 2021). It is your responsibility to ensure that each of your referee reports reach us.
No
No
No
University of the Western Cape. Private Bag X17. Bellville 7535. South Africa.
ATTACHMENTS
PLEASE ATTACH THE FOLLOWING INFORMATION TO YOUR APPLICATION.
YOU ARE REQUIRED TO ADHERE TO THE PRESCRIBED WORD LIMIT.
(Ms Word, Font: Times New Roman, Font size 12, Spacing: 1,5)
1
Personal Statement/Autobiographical Essay
The personal statement is intended to provide you with the opportunity to clarify your personal
and career/vocational goals, especially with regard to social research. The statement should not
exceed ONE page of typed text, and must be attached to this application form.
2
Research Statement
The purpose of this research conceptualisation is to:
(i) determine the level of your academic writing abilities, and
(ii) your ability to conceptualise the proposed research question.
Please write a brief, 3-5page proposal (including a list of references), of a topic of your choice.
Your proposal should include:
(i) a formulation of your research problem,
(ii) the aim{s),
(iii) a brief overview of the theoretical framework, and
(iv) the methodology of the proposed study.
I hereby declare that the above information is correct.
Full name: _____________________________
Signature: _____________________________
Date: _____________________________
Please ensure that you have read the document “MResearch Application Process: Instructions
and General Information” available on the Psychology website prior to completing and
submitting your application. Incomplete applications will not be considered.
This application form needs to be completed electronically in MS Word and not handwritten.
Please submit your Application form, with all required attachments to: Ms Neetha Nagan:
mresearchuwc@gmail.com
THE CLOSING DATE FOR MRESEARCH APPLICATIONS IS 30
th
SEPTEMBER 2021.
NO LATE APPLICATIONS WILL BE CONSIDERED.
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Private Bag X 17, Bellville 7535, South Africa, (North-West University)

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Completed 21 August 2021

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