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Bongani Mayosi National Health Scholars Programme - Application Form - 2021 Enrolment
Full applications must be completed online and all additional documents requested emailed to Ms Colleen Van Wyk on or before 20 July 2021 at
Colleen.Vanwyk@mrc.ac.za
/ Tel 021 938 0384
For enquiries contact: Dr Lindokuhle Ndlandla on
Lindokuhle.Ndlandla@mrc.ac.za
/ Tel 021 938 0442
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Personal details
Title (Ms, Mr, Dr)
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First Name
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Surname
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Gender
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Male
Female
Other:
Population group
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African
Coloured
Indian
Asian
White
ID Number
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Please email copy of South African Identity document
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Postal Address
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Physical Address
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Work telephone number
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where applicable
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Mobile number
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University eMail address
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Personal eMail Address
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Academic Information
Highest qualification
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Profession
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Years of experience in the profession
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Current position
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(where applicable)
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Employer
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(where applicable)
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Income per annum (pre-tax)
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(where applicable) - not older than three months
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Alignment of the proposed research to the SAMRC priority research areas
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Biomedical Research
HIV, TB and other communicable diseases
Health System Strengthening
Health Promotion and Disease Prevention
Maternal child and woman health
Non-communicable diseases
Public Health Innovation
Violence, injury and trauma
Are you registered for a PhD
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Year of PhD Study in 2021
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First Year
Second Year
Third Year
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University at which currently registered
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Date of first registration for the degree to be funded
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Email evidence
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Faculty
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Department
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PhD title of research project
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PhD supervisor
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Email address of supervisor
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PhD co-supervisor
(where applicable)
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My Research Project has Ethics Clearance
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The Post graduate office or equivalent office has accepted the project title
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