Eastcape Midlands College Application PDF Details

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QuestionAnswer
Form NameEastcape Midlands College Application
Form Length4 pages
Fillable?Yes
Fillable fields233
Avg. time to fill out23 min 50 sec
Other namesmidlands college, midlands college application forms 2021, eastcape midlands college online application 2021, east cape midlands tvet college online application 2021

Form Preview Example

EASTCAPE MIDLANDS TVET COLLEGE

APPLICATION FORM

STUDENT NUMBER

REGISTRATION NUMBER

HAVE YOU REGISTERED WITH EMC BEFORE?

Y

N

NB!! Please note that this is only an APPLICATION. Even if you have completed the form correctly and you comply with the minimum entry requirements, it does not necessarily mean that you have been accepted at EMC. We consider all applications and will inform you of the outcome.

APPLICATION FOR ADMISSION

INSTRUCTIONS:

Use capital letters to complete this form or place an X in the correct box.

Please use a black pen.

Kindly complete the form in FULL and answer all the questions.

Application forms that are not completed and do not include the required documentation may not be processed or the process might be delayed.

Please tick the area of your intended studies:

National Certificate Vocational (NCV)

 

Report 191

 

At which campus would you like to study?

Occupational / Skills Training

Business Studies

Grahamstown

Heath Park (Port Elizabeth)

High Street

Graaff-Reinet

Thanduxolo

Engineering Studies

Charles Goodyear

Park Avenue

Occupational / Skills Training

Brickfields Road

1. PERSONAL INFORMATION

Surname

Full Names

Date of birth

Marital status

 

Single

 

Maiden Surname

 

Married

Initial(s)

ID Number

RSA Citizen

Study Permit

Passport Number

Divorced

Title

Other

If other, please specify

Expiry Date of Permit

Widowed

Ethnic Group

 

Black

 

 

 

White

 

 

 

 

Coloured

 

 

 

 

Indian

 

 

 

 

Other

 

 

Home Language

Contact Details (Home)

Are you currently employed ?

If other, please specify

Gender

Please note that this question is asked to allow EMC and the government to track progress in the transformation of Technical and Vocational Education and Training (TVET)

(Cell)

Yes

No

Company Information: Name

Contact Details

Male

Female

Please note that your application form cannot be processed if you have not included all the following relevant documents.

Certified copy of your ID document

Certified copy of passport (for international students) / proof of permanent residency Certified copy of ID of parents / legal guardian / surety (required if you are a dependant) Certified copy of study permit (If applicable)

Grade 12: Certified copy of your grade 12 certificate including statements of results

Affidavit of unemployment (Occupational / Skills Training only)

Academic record from previous institution (If applicable)

Grade 9-11: Certified copy of your highest school qualification including statements of results

Have you and your parents/guardian signed section 10 Page 3?

Have you and your parents/guardian signed section 11 on page 4?

1

2.STUDENT ADDRESS HOME ADDRESS (Not PO Box)

Street Address

 

 

 

 

 

 

 

Suburb

 

 

 

 

 

 

 

Town

 

 

 

 

Code

 

 

POSTAL ADDRESS (If different from home)

 

ADDRESS WHILE STUDYING (If different from home)

Street Address / PO Box

Street Address / PO Box

Suburb

 

 

Suburb

 

 

 

 

Town

 

Code

Town

 

 

 

Code

3. NEXT OF KIN INFORMATION

(Father / Mother / Legal Guardian / Sister / Brother / Spouse / Partner*)

CERTIFIED COPY OF ID OF THIS PERSON TO BE SUBMITTED

Surname

Full Name

ID Number

EMPLOYER

CONTACT

DETAILS

PO Box / Private Bag

Street Address & number

Suburb

Town

Tel (H)

Cell

Email Address

Relation

 

 

 

 

 

 

 

 

Title

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

Initials

 

Full Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Initials

 

 

 

 

 

 

 

 

 

 

ID Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DETAILS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PO Box /

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Private Bag

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

& number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suburb

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Code

 

 

 

 

 

 

 

 

 

 

Town

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel (H)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel (W)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel (W)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cell

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. MEDICAL INFORMATION (Confidential)

Disabilities / Special Needs

 

 

 

 

Allergies / Health Problems

 

 

 

 

Contact Person

 

Relation

 

 

Tel / Cell

Medical Fund

 

Fund #

 

 

Main Member

Doctor

 

Dr. Tel

 

 

 

5. INSTITUTIONAL ACADEMIC BACKGROUND

1. Secondary School Student

 

2. University

 

3. Student at this TVET College

4. Student at other TVET College

 

5. University of Technology

 

Name of last institution attended

 

 

 

 

 

 

 

 

6. PREVIOUS QUALIFICATIONS

SCHOOL QUALIFICATIONS

 

 

POST SCHOOL QUALIFICATIONS

 

 

 

 

 

 

 

 

Names of School

 

 

Name of

Institution

 

Highest grade passed

 

 

Study Direction

 

Year

 

 

In which year have you completed Grade 12?

 

Highest level passed in the following subjects:

 

Highest level/symbol passed in the following subjects in Grade 12

Science

 

 

Science

 

 

 

Maths

 

 

Maths

 

 

 

Maths Lit

 

 

Maths Lit

 

 

 

English

 

 

 

 

 

 

Grade 12:

 

 

 

 

 

 

With Endorsement

Without Endorsement

 

 

 

 

7. TYPE OF STUDENT

Private

Employed

Unemployed

Bursary

Bursary Company

 

 

8. CHOICE OF COURSE

 

1st Course

2nd Course

 

3rd Course

 

 

 

9. SUBJECTS (TO BE COMPLETED BY EMC OFFICIAL)

SUBJECTS

LEVEL

FULL-TIME

PART-TIME

LANGUAGE AFR / ENG

Practical / Non-Formal course

2

10. UNDERTAKING

I hereby declare:

1.that the information provided by me on the previous page in this application form is true and correct;

2.that I undertake as a prospective registered student of EMC to abide by all the rules and regulations of the College, including any amendments thereto and any substitutions thereof;

3.that I undertake not to bring any claim, of whatever kind against the College, or any employee of the College, nor in any way to hold the College liable for any damage or loss whatever which I may incur or suffer personally or in property of mine and which directly or indirectly arises from my participation as a student at the College in any activity, concerning my studies, training, sport or recreation, however such damage or loss may come about, and that I will participate in any such activity on my own responsibility and will accept of me own free will the risk attached thereto;

4.that I authorize the College in the event of my requiring urgent medical treatment to get appropriate medical assistance and that I accept responsibility for the payment of the costs thus incurred;

5.that I undertake to pay all class- and other fees punctually. I am responsible to pay an admin fee if I want to cancel a subject or course within the first 10 working days and 50 % of the course fee after 10 working days of the commencement of the said term. In the event of completing 50% of the said course reckoned from the commencement of the said term; I undertake to pay the full balance irrespective of whether or not I attended or abandoned classes.

6.that I should regard myself liable for payment of tuition fees should I not qualify for financial aid.

7.that I furthermore undertake to defray all legal costs arising for the College in the event of my failure to discharge any duty relating to the payments mentioned in (5) above;

8.that a 80% class attendance in all subjects is required at EMC for admission to exams and a term mark as prescibed by DHET examinations policy.

9.that I undertake to let the College know of any changes to the information provided in this form, with in 10 working days;

10.that it is my responsibility to make enquiries about commencement of classes and exam dates;

11.that it is my responsibility to make enquiries about my results (when it is available);

12.that I agree that the course level that I am applying for is best suited for my qualifications and abilities.

13.I hereby declare that I am an unemployed learner (Applicable for NSF learners only).

Signature of Student

Signature of Parents / Guardian

if student is under 18 years of age

Date

WHERE DID YOU HEAR ABOUT EMC, OR WHAT MADE YOU DECIDE ON EMC AS A STUDY OPTION (CHOOSE AS MANY AS APPICABLE)

Newspaper adverts

Twitter

From the internet (website)

Open Day

From career expo

From friends or family

From a community leader / paster

Other

Facebook

Radio advert

Call from the EMC Contact Centre

From school guidance teacher

Visit to school by staff members

From a brochure / poster / banner

Private Bag X35, Uitenhage, 6230

Eastcape Midlands College - CorporateProfile

ContactTel: +27(0)86Us038 8879 (ShareandCall) Lets@MidlandsColleg1Connect

Fax: +27(0)41 922 0156

eastcapemidlands

 

www.emcol.co.za

3

11.CONDITIONS

1.A registration fee as determined by the College Governing Body is payable at the beginning of a course term.

2.Cancellation or change of subject(s) or course must be discussed with the Campus Manager and written proof must be submitted.

3.No changes of subjects will be accepted after 10 working days of commencement of classes.

4.An administration fee will be charged if classes are cancelled within 10 working days from the commencement of the said course.

5.Cancellations due to death and terminal sickness will be considered on merit and is subject to the approval of the Principal.

6.If classes are abandoned or cancelled for no very sound reason as stipulated in condition 5, the full tuition fee is payable.

7.Students who attend classes have a period of two days after publication of the examination results to do any adjustments to their enrolments.

8.(i) In the event of the student cancelling after 10 working days reckoned from the commencement of the said term 50% of the course fee shall become due and payable irrespective of whether the student changes and/or abandons and/or terminates his/her course of study. (ii) In the event of a student completing 50% of the said course reckoned from the commencement of said term; the full balance of the course fee shall become due and payable irrespective whether the student changes and/or abandons and/or terminates his/her course of study.

9.In addition to the aforementioned the student and/or parent and natural guardian where applicable hereby consents to any legal action being instituted for recovering of outstanding fees in the magistrates court.

10.In the event of any course fees being outstanding the college shall in its sole discretion be entitled to refuse admission to any defaulting to the final examination at the end of the said course term.

11.80% Class attendance and prescribed minimum term marks are compulsory for each subject in order to gain admission to the final examination at the end of any course term. For learnerships: (i) 80% Attendance per unit standard is compulsary to attempt summative assessment (ii) Only two attempts per summative assessment allowed.

12.Students must submit proof of RSA Identification Number (or Study Visa) and previous academic successes.

13.EMC must be informed in writing within 10 working days of any address changes.

You agree that we may:

1.verify information provided by you;

2.seek information from any credit bureau when assessing your application for credit and at any time during your continuing indebtedness to us including tracing or confirming your whereabouts

3.disclose the existence of your account to any credit bureau, sharing both positive and negative payment information about such account;

Furthermore, you agree that we will be entitled to obtain and disclose the above information:

if we consider that it is necessary or may be of benefit to you;

where we are under legal obligation to do so;

where it is in your own or the public interest that we do so

Furthermore, you agree that you will be held accountable for all collection fees, tracing fees, necessary expenses, interest, collection, commission, legal costs and legal expenses etc. incurred.

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SIGNATURE OF STUDENT

DATE

SIGNATURE OF APPLICATION OFFICIAL (EMC)

---------------------------------------------------------------

----------------------------------

 

SIGNATURE OF PARENT / GUARDIAN

DATE

 

The completed application form duly signed by the above student and where applicable, parent or legal guardian represents the formal contract of enrolment with Eastcape Midlands College subject to the conditions referred to above.

COMPULSORY CERTIFIED COPIES (FOR OFFICE USE ONLY)

ID

Highest School qualification

PACE-Results

Previous Academic Results

Affidavit of unemployment (O/T)

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SIGNATURE OF COLTECH CAPTURER (EMC)

NAME & SURNAME

DATE

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SIGNATURE OF ADMISSION OFFICIAL (EMC)

NAME & SURNAME

DATE

4

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