Transcription of APPLICATION FORM - Distance
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APPLICATION FORM - Distance
Page 1 of 6 Revised 01/06/2017 UNIVPREP STUDENT NUMBER (Office use) only) APPLICATION FORM North-West University Preparatory Programme (UnivPrep) A. PERSONAL DETAILS Surname First Name(s) Maiden Name (if applicable) Title (Mr / Ms) Date of Birth y y y y m m d d Age Gender Male Female Marital Status Married Single Population Group: African Coloured Indian White Asian Citizenship: SA Other Please specify Other South African ID Number Foreign Nationality: Indicate country of origin - Study Permit Number Attach copy of study permit - Expiry Date of Permit - Passport Number Attach copy of passport Home Language Disability Yes No If Yes , please specify: B.
The Learning Support Centres listed below were functional at the time of compiling this application form and may vary from year to year according to the number of enrolled participants. Not all listed centres will be functional to present UnivPrep programmes. Only those centres with sufficient enrolments will be selected.
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