FOR OFFICE USE:

CENTRE/SITE:

ENGINEERING AND SKILLS TRAINING CENTRE

IT AND COMPUTER SCIENCE CENTRE

BUSINESS STUDIES CENTRE

PREVIOUS STUDENT: YES/ NO LEVEL (IF YES):

APPROVED: YES/ NO

WAITING LIST: YES/ NO

BURSARY STUDENT: YES/ NO

ATTACHMENTS: YES/ NO

FOR OFFICE USE: (CAP)

PLACEMENT

ASSESSMENT

DATE TIME : VENUE

PLACEMENT LETTER DATE RECEIPT NO DEPOSIT

SLIP

YES NO

PLACEMENT OPTION

OA

FEA

MARK

CEBC

EIC

ERD

HOSP

IT

PA

TOUR

N4-N6

N1-N3

OTHER

APPLICATION FORM

A. STUDENT:

COURSE

INTERESTED IN

(Cross out

course

interested in)

Office Admin

Finance,

Economics and

Accounting

Marketing

Civil

Engineering and

Building

Construction Electrical

Infrastructure

Construction

Engineering and

Related Design

Hospitality

IT and Computer

Science

Primary

Agriculture

Primary Health

Tourism

HATED N4-N6

(Business)

NATED N1-N3

(Engineering)

OTHER

Specify OTHER:

TITLE

MR MS

SURNAME

INITIALS

FIRST NAMES

BIRTH DATE

Y Y Y Y M M D D

GENDER

MALE FEMALE

ID NUMBER

FOREIGN/INTERNATIONAL STUDENT ONLY

CITIZENSHIP

SAQA YES NO PERMIT YES NO PASSPORT YES NO

STUDY PERMIT NO

EXPIRY DATE

B. STUDENT CONTACT DETAILS:

ADDRESS (POSTAL)

BOX NUMBER TOWN/VILLAGE CODE

ADDRESS (HOME)

HOUSE NUMBER TOWN/VILLAGE CODE

ADDRESS (STUDY)

HOUSE NUMBER TOWN/VILLAGE CODE

CONTACT NUMBERS MOBILE

TEL (H) TEL (W)

C. BIOGRAPHICAL INFORMATION:

MARITAL

STATUS

SINGLE S MARRIED M DIVORCED D WIDOWER W

HOME

LANGUAGE

Afrikaans A English B IsiNdebele C Sepedi D SiSwati E Xitsonga F Tshivenda G Setswana H IsiXhosa I IsiZulu J Sesotho K Other I ETHNIC

GROUP

WHITE 1 COLOURED 2 INDIAN 3 BLACK 4 COURSE TYPE VOCATIONAL SKILLS D. HEALTH:

ALLERGIES

PSYCHIATRIC DIABETES

ASTHMA

CHRONIC MEDICATION NONE

Tick and specify if applicable

MEDICAL AID

DOCTOR NAME

MEDICAL AID NUMBER

DOCTOR TEL NO

E. PARENT(S)/GUARDIAN(S)/NEXT OF KIN:

INITIALS AND

SURNAME

MR MS REV DR PROF

INDICATE RELATIONSHIP

TO STUDENT

ADDRESS

(POSTAL)

BOX NUMBER TOWN/VILLAGE CODE

CONTACT

NUMBERS

MOBILE

TEL

(H)

TEL (W)

ID NUMBER

AND/OR

INITIALS AND

SURNAME

MR MS REV DR PROF

INDICATE RELATIONSHIP

TO STUDENT

ADDRESS

(POSTAL)

BOX NUMBER TOWN/VILLAGE CODE

CONTACT

NUMBERS

MOBILE

TEL (H) TEL (W)

ID NUMBER

F. DISABILITY:

Specify and attach a certified medical certificate or proof of disability status if applicable Attention Deficits Disorder

with/without ADHD

01

Deaf/Blind Disabled

07

Physical Disabled

13

Autistic Spectrum Disorder

02

Epilepsy

08

Severe Intellect Disabled

14

Behavioural/Conduct Disorder

03

Hard of Hearing

09

Specific Learning Disabled

15

Blind

04

Mild to Moderate

Intellectual Disabled

10

Psychiatric Disorder

16

Cerebral Palsied

05

Multiple Disabled

11

Dyslexia

17

Deaf

06

Partially Disabled

12

None

G. HIGHEST GRADE PASSED:

GRADE 12 STUDENT

GRADE 10 STUDENT

GRADE 11 STUDENT

GRADE 9 STUDENT

Indicate name of school above

H. HOSTEL:

WILL YOU NEED ACCOMMODATION/HOSTEL SPACE DURING YOUR STUDIES? YES NO

Student: Initials and Surname Date

Student: Signature

Parent/Guardian: Initials and Surname Date

Parent/Guardian: Signature

All students who want to register must provide the following documents:

Original copy of results for the highest grade passed

Two (2) certified copies of student ID document

Certified copy of parent(s)/guardian(s) ID document(s)

If foreigner, two (2) certified copies of study permit and passport Please return completed form to: Waterberg TVET College: Marketing Department, Postnet Suite #59, Private Bag x2449, MOKOPANE, 0600

Contact this candidate