South Cape College Application Form – Fill Out and Use This PDF

PLEASE PRINT AND USE A PEN WITH BLACK INK

Please mark relevant blocks with ‘x’

SHADED AREAS FOR OFFICE USE

A.1 STUDENT’S PERSONAL INFORMATION

Surname

Title

Mr

Miss

Other

Initials

ID

Date of Birth

DD

MM

YYYY

Preferred Name

YYYYYYYY

Full Names

Age

RSA

Y

N

Nationality / Country

Immigration date if

DD

MM

YYYY

Passport

Citizen?

of Citizenship

not RSA citizen

YYYYYYYY

No.

Do you have a study permit if

Y

N

What is your Study

Expiry date of

DD

MM

YYYYYYYY

Gender

Female

Male

Other

you are not a RSA Citizen?

Permit Number?

permit?

YYYY

Ethnic Group (to enable the South Cape College and the

Black, e.g. Xhosa, Zulu, Tswana, Sotho, Venda (please circle)

Government to track transformation in the Further Education

Coloured

White

Indian

Asian

Other (please specify)

& Training Sector)

Marital

Single

Married

Divorced

Maiden Name

Car Registration

Transport Type

Car

Taxi

Bus

Accommodation

Private

Hostel

Mother

Afr.

Eng.

Xhosa

Zulu

Sotho

Venda

Tswana

Tongue

Other (Specify)

Home

Afr.

Eng.

Xhosa

Zulu

Sotho

Venda

Tswana

Other

Religion

Language

(Specify)

A.2 STUDENT’S CONTACT DETAILS (‘STUDENT SCREEN’) (Please enclose proof of residential address, e.g. a Municipal account))

Tel. No. (H)

Tel. No. (W)

Fax No.

Cell No.

E-mail

Residental Address:

Adress Line 1

Suburb

Adress Line 2

Town

Postal Code

A.3 CONTACT DETAILS (GUARDIAN SCREEN’)

Person to whom the student’s report must be posted, e.g. Student /

Person liable for the payment of the student’s account, e.g. Student / Parent /

Parent / Guardian / Employer / CETA / Other (Underline relationship)

Guardian / Employer / CETA / Other (Underline relationship)

Surname

Surname

Name

Name

Initials

Initials

ID

ID

Tel. No. (H)

Tel. No. (H)

Tel. No. (W)

Tel. No. (W)

Fax No.

Fax No.

Cell No.

Cell No.

E-mail

E-mail

Address Line1

Address Line1

Address Line 2

Address Line 2

Suburb

Suburb

Town

Town

Postal Code

Postal Code

Student’s Province of

Eastern

Free

Gauteng

Kwa-Zulu

Mpumalanga

Northern

Northern

Western

Other (Specify)

Origin

Cape

State

Natal

Prov.

Cape

Cape

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B. COURSE (REGISTRATION INFORMATION)

D.	Highest Level of Education (School)			Post School Training and Qualifications (Please Provide Proof)
Grade	Year	School/Institution	Matric
			Aggregate

E. STUDENT SUPPORT AND MARKETING (For statistical purposes)

Designated Groups

Unemployed

Employed

YAR

SCL

Do you have a medical

If Yes,

Learning (Specify below)

Y

N

Hearing

Speech

Psychological

Physical

Sight

Wheel chair

condition or disability?

Specify

F. MEDICAL INFORMATION (Only full-time students)

G. SPORT ACHIEVEMENTS (Only full-time learners)

METHODS OF PAYMENT

For your information, please take note of the various payment options that are available once you have been accepted to study at the College. With registration, a specified amount (depending on the course) must be paid by students following the full-time or part-time courses. The balance of the fees may be paid according to the various options. Payment can be made in the following ways: Cheque (payable to the South Cape College with student number written on the back); cash to the campus cashier; bank deposit or electronic transfer. Always state your student number, ID, initials and surname for reference purposes. Each campus will provide their bank details.

H. DECLARATION AND UNDERTAKING (COMPULSORY)

Please read the following carefully before completing and signing the form. The term “College” refers to “South Cape College”.

1. ENTRANCE REQUIREMENTS

•All Candidates who comply with the minimum requirements are still subject to placement assessments.

•All candidates must note that the offering of a course is subject to a minimum enrolment. Any course that does not meet the minimum enrolment requirement will be cancelled. Any fees already paid will be reimbursed.

2. DOCUMENTS

A certified copy of the first page of your identity document (or certified copy of your passport) must accompany this application. A Certified copy of your Senior Certificate or equivalent qualification must be submitted with your application. If you are still in Grade 12, your marks obtained in Grade 11 together with your most recent Grade 12 marks must be submitted. If you attended any other tertiary institution, an original academic record and a certificate of conduct, or certified copies of other certificates / diplomas / degrees obtained previously, must also be submitted.

3. DEPOSIT

The deposit as prescribed for the course must be paid before your registration will be confirmed. Should you cancel your course before the commencement of classes, R100 of your deposit will be kept for handling fees and the remainder will be refunded.

4. GENERAL

This form must be completed by all students applying to the College for the first time. It is in your own interest to ensure that this form is completed in full and that certified copies of all supporting documents are enclosed. If any questions are left unanswered or certified documents are not enclosed, or the contract is not signed, it will cause a delay as the form will be returned to you for completion. Write only in black ink and block letters.

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CONTRACT

I, the undersigned student, hereby declare that the above particulars furnished by me in this application form, are true and correct;

(a)that I undertake to inform the Administrative Office immediately if I abandon my course or studies and/or change my address or any other personal details by completing the prescribed form available at the Administrative Department;

(b)that I fully understand that the College is entitled to cancel my registration immediately, should it become apparent that any of the particulars furnished above in this application form are false or incorrect;

(c)that I have acquainted myself, and in the future will keep myself acquainted with the College rules, Student Code of Conduct and Language Policy framed from time to time by the Council of the College or by any other competent body or person attached to the College;

(d)that I understand and agree that the College’s medium of tuition is both Afrikaans and English and I accept that lecturers may make use of both of the aforementioned languages in the lecturing situation. Furthermore I undertake not to make any claims against the College regarding the medium of tuition.

(e)that I undertake throughout all the years for which I am registered as student of the College, for whatever programme of study direction, to abide by all the rules and regulations referred to in (c) above, including any amendments thereof and any substitutions thereto;

(f)that I undertake not to bring any claim, of whatever kind against the College or any employee of the College nor in any way whatsoever to hold the College liable for any damage or loss whatever which I may incur or suffer personally or to property of mine and which directly or indirectly arises from my participation during my period of study at the College in any activity, of whatever kind, related to my studies or training or with sport or recreation of any kind whatsoever, 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 my own free will the risk attached thereto;

(g)that I authorise 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;

(h)that I will immediately get the necessary medical advice or treatment if I have reason to suspect that I have any contagious or infectious disease capable of creating a risk for other persons through my participation in any aspect of College activities, including, without restriction, residence in College accommodation, attendance of any instructional occasion, taking of examinations or tests or participation in College-related projects, sport or recreation; and that, if in terms of such medical advice it is desirable, I will withdraw from any such College activity; and that I indemnify the College against any liability of whatever nature that may directly or indirectly arise from the College in consequence of my failure to comply with this undertaking;

(i)that I undertake to pay punctually all such tuition, class, residence and other fees as the College may from time to time charge during the years for which I am registered as a student of the College;

(j)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 (g) above;

(k)that I am liable for legal costs incurred if my account is handed over to debt collectors due to non-payment;

(l)that exam admission is subject to the guide-lines of the National Examination department;

(m)that, if I abandon or change my course of study after two weeks, no cancellation or reduction of fees will be considered and that I will remain liable for the payment of all fees in full, except in the event of serious illness, death or transfer to another college. Credits (if any) will be transferred to the other institution. Provide proof of registration and banking details of institution.

SIGNATURE OF STUDENT ____________________________________________ DATE _________________________________

I. DECLARATION BY PARENT / GUARDIAN / PERSON RESPONSIBLE FOR PAYMENT OF ACCOUNT (COMPULSORY)

I hereby declare

(a)that I have acquainted myself with the contents of, and consent to, the declaration by the applicant in F above and that the particulars furnished by him/her in this application form are true and correct;

(b)that I consent in particular to my minor child's / ward's / applicant’s undertaking throughout all his/her years of study to abide by the College code of conduct, rules and regulations as framed from time to time by the Council of the College or by any other competent body or person attached to the College;

(c)that I accept joint and several responsibility with my minor child / ward / the applicant for the payment of all fees referred to above which may become due and payable to the College during all the years for which he/she registers as a student of the College (including studies subsequent to his/her attainment of majority) and that I undertake to pay the said fees punctually;

(d)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 he/she may incur or suffer personally or to property of mine and which directly or indirectly arises from my child's / ward's / the applicant’s participation during his/her period of study at the College in any activity, of whatever kind, having to do with his/her studies or training or with sport or recreation of whatever kind, however such damage or loss may come about, and that he/she will participate in any such activity on his/her own responsibility and will accept of his/her own free will the risk attaching thereto; and I furthermore undertake to indemnify the College or any employee of the College if my minor child / ward / the applicant with my assistance is on legally valid grounds unable to safeguard the College against liability as set forth hereinbefore.

Herein assisted as far as may be necessary while the applicant / student is still under the age of eighteen (18) years or not liable for the payment of own fees.

I, ________________________________________________________________________ the undersigned, hereby acknowledge myself

to be jointly and separately responsible for monies which the above-mentioned applicant may at any stage be owing to the College in terms of the agreement he/she concluded with the College, as set out above, including any change thereto.

SIGNATURE OF PARENT / LEGAL GUARDIAN __________________________________ DATE___________________________

ID OF PARENT / LEGAL GUARDIAN

IT IS COMPULSORY THAT THIS CONTRACT IS SIGNED BY ALL PARTIES CONCERNED.

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