Student number Student number to be completed by the College Official Surname Initials Title Mr Mrs Ms Miss APPLICATION FOR ADMISSION 2015 (New Entrants) THE CLOSING DATES FOR APPLICATIONS ARE AS FOLLOWS: 1. Applications commence on 17 November 2014. 2. Applications close on 28 November 2014 3. A non- refundable administration fee of R200 for application payable. 4. Certified copies of your identity document, qualifications obtained and all other relevant documents must accompany the completed application form. 5. LATE applications will be considered only if space is available. 6. Induction and PLACEMENT test will be done at all campuses on 8 - 9 December 2014. It is important and necessary to attend these sessions. Exact dates will be communicated to you by phone. 7. Completion of this application form does not guarantee an automatic registration. Selection and screening will be adhered to Mark with anX the CAMPUS where you want to study: ALBERTON BOKSBURG GERMISTON KATHORUS KEMPTON TEMBISA STUDY PERIOD Year Trimester Semester 0 T1 S1 PROPOSED QUALIFICATION QUALIFICATION Subject 1) 1st Prefference 2) 2nd Prefference SUBJECTS to be completed by the Campus Official Subject Description Offering Type 1 STUDENT PERSONAL DETAILS Surname Initials Title Mr Mrs Ms Miss Full names Maiden name (if married) Date of birth d d A m m y y y y Afrikaans E English G SiSwati H XiTonga I SetTswana J TshiVenda K IsiXhosa L IsiZulu O IsiNdebele S SePedi S Single M Married D Divorced Population group 1 White 2 Coloured 3 Indian RSA 2 Permanent Residence ID number Passport number Home language Marital Status Citizenship 1 4 Black 3 Other (Please specify) Highest School Grade Passed Other qualifications Disability Institution Yes No If yes, please specify: CONTACT INFORMATION OF STUDENT (PC) Postal address (PA) Street address (SA) Communication details Cell Home Work email Postal Code Postal Code CONTACT INFORMATION OF PARENT/GUARDIAN/NEXT OF KIN (NC) Postal address (PA) Street address (SA) Communication details Cell Home Work email Postal Code Postal Code Relationship CONTACT INFORMATION OF PERSON RESPONSIBLE FOR ACCOUNT (AC) Postal address (PA) Street address (SA) Communication details Cell Home Work email Postal Code 2 Postal Code Relationship WHERE DID YOU HEAR ABOUT EKURHULENI WEST COLLEGE? Career exhibition Former student Guidance teacher Radio Friend Internet School visit Family Current student Open day Word of mouth TV MEMORANDUM OF AGREEMENT Should my application be successful – I, __________________________________________________________ _____________ declare that – 1. All particulars given my me in this form are true and correct; 2. I will acquaint myself with the rules and regulations of the Ekurhuleni West College and will abide by them; 3. I will inform the Administration immediately, in writing, should I change my address or cancel or change my course or any subjects; 4. I am aware that my application is only valid if it complies with the relevant regulations of the College; notwithstanding provisional acceptance of this enrolment by the College; 5. I am aware that fees and legal costs will be recovered from me should I fail to fulfil my financial commitment towards the College; (a) I am capable of concluding an agreement and am legal competent to sign this application and therefore enter unassisted into an agreement with the Ekurhuleni West College; and (b) I sign this application and enter into an agreement with the Ekurhuleni West College with the permission of my parents/guardian. 6. (Delete (a) or (b), whichever is inapplicable); 7. I accept full responsibility for the payment of all class fees as well as any other fees determined by the Ekurhuleni West College. Signature of applicant: _______________________________________ Date: ______________________________ Herein assisted as far as may be necessary while the applicant or student is still under the age of eighteen years. I, _____________________________________________ the undersigned, in my capacity of parent or legal guardian hereby admit that I am to be jointly and separately responsible for moneys, the above applicant may at any stage owe the Ekurhuleni West College in terms of the agreement that he/she has concluded with the College, as set out above, including any alteration to such agreement. Signature of parent/legal guardian: _____________________________ Date: ______________________________ IT IS COMPULSORY THAT THIS CONTRACT BE SIGNED BY ALL PARTIES CONCERNED. Please apply for a bursary… enquire at the administration office 3 CHECKLIST Certified copy of student’s ID/Passport Certified copy of previous results Proof of residence Form completed in full A copy of proof of payment of Application Fee A certified copy study permit where applicable OFFICE USE ONLY TASK Signature Date Biographical Captured by: Qualification/Subjects Captured Checked by HOD Filed by The application fee to accompany the application form can be deposited at: BANK NAME: ABSA ACCOUNT NAME: Ekurhuleni West College ACCOUNT NUMBER: 40 5539 2078 REFERENCE: Your ID number must be used as reference on your diposit slip Attach the deposit slip to the application form Hand your application in at campuses of your choice listed below: Alberton: 25 Lake Arthur Street, Brakendowns Boksburg: 49 North Street, Plantation, Boksburg Germiston: Cnr. Driehoek & Sol Roads Kathorus: 782 Palime Section, Katlehong Kempton: Cnr. Partridge Avenue & Pretoria Road Tembisa: 9 Esiqongweni Section, Tembisa 4