APPLICATION FOR ACADEMIC ADMISSION TO …

1 MAIN CAMPUS (VANDERBIJLPARK)ANDRIES POTGIETER BOULEVARDPRIVATE BAG X021 VANDERBIJLPARK1900 CONTACT NUMBERSCALL CENTRE: 0861 861 888 APPLICATION FOR ACADEMIC ADMISSION TO STUDIES(NEW NATIONAL STUDENTS)FOR CONTACT DETAILS OF OTHER VUT CAMPUSES, SEE OVERLEAFAPPLICATION FORADMISSIONCLOSING DATE FOR applications : 30 SEPTEMBERP lease note: To avoid disappointment, prospective students are urged to apply as early as possible before theclosing date. Make sure that VUT offers the course you are interested in (see overleaf) and that you adhere to the admissionrequirements. Initial selection will be based on final Grade 11 or any Grade 12 results (final, mid-year and/or 3rd quarter).HOW TO the APPLICATION form in full and answer all in plain block letters in the squares and use a black only the appropriate answer with an X in the squares where options are FOLLOWING MUST BE SUBMITTED WITH YOUR copy of South African green bar-coded identity copy of final Grade 11 or any Grade 12 Fee of forms without proof of payment will not be accepted.

2 NB: In case of applications submitted by mail,payments will only be accepted by bank deposit (ABSA Bank - account no.: 530 861 945; branch code:632005; reference: your identity number), postal order or bank guaranteed cheques made out to the VaalUniversity of Technology. No cash should accompany your APPLICATION form. Send completed form with the abovementioned to the campus of your STATUS SELF-CHECK:Go to VUT website : and click on "admissions new students" and follow the OF MANAGEMENT SCIENCESCost and Management Accounting (204212)Internal Auditing (204210)Financial Information Systems (204061)Human Resources Management (204147)Marketing (204075)Retail Business Management (204173)Sport Management (219007)Logistics (204190)FACULTY OF ENGINEERING AND TECHNOLOGYC hemical Engineering (208086)Civil Engineering (208087)Industrial Engineering (208085)Mechanical Engineering (208082)Metallurgical Engineering (208088)Engineering.

3 Computer Systems (206017)Electrical Engineering Electronic Engineering Power Engineering Process InstrumentationVANDERBIJLPARK (MAIN) CAMPUSFACULTY OF APPLIED AND COMPUTERSCIENCESA nalytical Chemistry (215054)Biomedical Technology (209049)Biotechnology (215052)Non-Destructive Testing (215048)Information Technology (IT) (206010)FACULTY OF HUMAN SCIENCESF ashion (210015)Photography (203010)Graphic Design (203030)Fine Art (203009)Hospitality Management (204220)Public Relations Management (205004)Tourism Management (222017)Ecotourism Management (204800)Legal Assistance (212801)Labour Law (212800)Safety Management (204179)Policing (221031)TEAR OFF AND KEEP THIS PAGECOURSES OFFERED AT VUT CAMPUSESThe Campus PrincipalPrivate Bag X025 Kempton Park, 1620 Tel: 011 929 7400 Physical address:Cnr.

4 R59 and Brazil Street,Daveyton, 1501 OTHER VUT CAMPUSESThe Campus PrincipalPO Box 2468 Upington8800 Tel: 054 332 3304 The Campus PrincipalPO Box 3595 Secunda2302 Tel: 017 631 1990 / 1971 EKURHULENISECUNDAUPINGTONCOURSESI nformation Technology (IT)Tourism ManagementMarketingInternal AuditingCost and Management AccountingCOURSESS afety ManagementChemical EngineeringElectrical Engineering Power Engineering Process Instrumentation Information EngineeringCost and Management AccountingCOURSESA gricultural ManagementInternal AuditingCost and Management AccountingMarketingTourism ManagementHuman Resources Management(208083)VANDERBIJLPARKSECUNDAE KURHULENIUPINGTONAPPLICATION CAMPUS03 SurnameMrTitleMs01 ProfDrOther (give abbreviation)PART APERSONAL Names07 Maiden name (if married)Marital statusSingleMarriedSMDivorcedWidow/erDW0 60812 Church Denomination13 Current ActivityStudentLabour force345 Home LanguageEnglishZuluSwaziLEOther / EuropeanCAEnglish / / BlackTswanaMBNorthern SothoDSouthern SothoFAfrikaansHTsongaGIJKX hosaVenda1109 MaleFemaleMFGender10 SelfNSFASS ource of FundingPrivate BodyDMYEARDate of birth04 ACADEMIC YEARC ourse for which you wish to enrolFirst choiceSecond choice (if applicable)Full-time study (day classes)Par t-time study (evening classes)Full-time study (day classes)Par t-time study (evening classes)STUDENT OFFICE USE ONLYDATE RECEIVED ADMISSIONS[STAMP]BACK FROM FACULTY[STAMP]FACULTY[STAMP]OtherName of your Religion:Have you ever applied at VUT before?

5 YesNoIf yes, please give detailsSecondary pupil (Grade 12)University student16 How were you occupied for the greater part of the last semester/year?0801 University of Technology studentFET / TVET College0305 Labour force (employed)Other0709 PART CSCHOOL PARTICULARS: OTHER ACTIVITIESP opulation group14 WhiteColoured12 CitizenshipSouth AfricaName of other Country:15100 AsianBlack34 PART BNATED DETAILSWill you apply for subject exemptions?Yes*No1921 Examination number20 Date of Matriculation / Senior Certificate (Final Gr 12)YEARMType of Senior CertificateMature Age ExemptionForeigners ExemptionImmigrants ExemptionOther Senior CertificatesFET / TVET College220405060708 ADMISSION to BachelorsAdmission to CertificateAdmission to DiplomaBCDM atric aggregate23 Name of school and town/city where school is situatedTown/cityName of school24 Please attach CERTIFIED COPIES of the following:(a)Grade 12 or equivalent certificate.

6 (b)Latest Grade 12 report ( June examination).(c)Certificate of conduct (if previously enrolled at another tertiary institution).(d)Statement of results (if previously enrolled at another tertiary institution).(e)Any other formal qualifications you have attained.(f)Identity document.(g)Proof of address (not compulsory). :A Grade 12 report ( June examination) or theGrade 12 advice of results only grants CONDITIONAL ADMISSION . Final ADMISSION will be granted only onreceipt of a certified copy of your Senior Certificate atStudent Administration (CW Building), and if all theadmission requirements of the University are met andthere is space Authority Mpumalanga25 Par ticulars of all post-secondary studyInstitutionDiploma/DegreeSubjects passedYear*If Yes, please submit your APPLICATION forexemptions upon receipt of acceptance registered as a student, or attempted tertiary education, give name of Institution18 Have you ever been registered with a Higher Educational Institution?

7 17 Yes*NoYear(s)Qualification / Course(s)*If Yes, include the ACADEMIC Record / Transcript from the Institution attendedTranscript from the Institution attended is requiredPART DGENERAL INFORMATION26Do you have a disability?27 Tick the relevant circle if you suffer from a disability:MobilityHead injuryVisual or partial impairmentCerebral PalsyHearing impairmentQuadraplegicSpina BifidaIf yes, please tick the correct :No:Physical DisabilityADHDE pilepsyDyslexiaOther: (please specify)Learning Disability28aDo you suffer from poor health? Yes: No:If yes, please specify:28bAre you on chronic medication? Yes: No:If yes, please specify:Offering type29 Vanderbijlpark campusFull-time study (day classes)Par t-time study (evening classes)0001 VFVPU pington campus(No residence accommodation)Full-time study (day classes)Par t-time study (evening classes)0015 UFUPE kurhuleni campus(No residence accommodation)Full-time study (day classes)Par t-time study (evening classes)0014 EFEPS ecunda campus(No residence accommodation)Full-time study (day classes)Par t-time study (evening classes)0002 HFHPR esidential Address33 Street Name and NumberSuburbTownPostal CodeTel.

8 CodeName and address of parent / guardian / relative not staying with you32 TitleMrMsDrProfRevThe (give abbreviation)NameAddressTel. CodeAccounts to31 TitleMrMsDrProfRevThe (give abbreviation)NameAddressTel. address30 Postal CodeTel. All the sections provided for addresses (30 - 33) must be your illness/disability what kind of assistance will you require to make your ACADEMIC experience workable?E-mailFunding is available for all disabled applicants whose APPLICATION for ADMISSION is comply with the rules and regulations of the Vaal University of Technology, should my APPLICATION be successful; inform the University immediately, in writing, if I change any biographical information ( postal address, contactinformation, etc.); acquaint myself, each year/semester, with all the rules and general regulations including class, residence and other relevant feeincreases, that relate to the programme for which I am hereby absolve the Vaal University of Technology, its staff, employees, representatives and/or agents from any claims which I/thestudent may acquire as a result of any injuries which I/the student may receive and/or damages which I/the student may suffer as a resultof any happening, incident, accident, injury, illness or death, however it may have resulted.

9 Or as a result of my/his/her participation in anysport/tour/outing/excursion/visit or transport which may take place during my/his/her studies at the undertake not to participate on behalf of a country club without the permission of the Dean of accept that I/the student shall participate in the activities mentioned in paragraph 2 on my/his/her own responsibility and shallvoluntarily accept the risk incidental hereby accept liability for the payment of all study, class or other fees which may from time to time be charged by the University as aresult of my/his/her studies at the University, if the APPLICATION is am aware that my enrolment is valid only if it complies with the regulations of the programme concerned and other regulations of theUniversity, irrespective of the acceptance of this APPLICATION by the I shall be held liable for payment of all monies owed by myself, my child or my ward as a result of my connections with theUniversity; in the event that the University instructs Attorneys to take any steps against myself for the recovery of any amounts due to theUniversity by myself, that I shall pay all costs as between Attorney and client, inclusive of collection commission; I conclude this agreement with the knowledge and consent of my parent/guardian/employer; all particulars given by me on this form are true and correct.

10 I have taken cognisance of the fees payable and the fact that class, residence and other fees are revised annually by theUniversity and increased am aware that the Fees charged by the University may be increased from time to time. Refer to a separate Fees signing this form I (tick the relevant box/es) permission to the University to perform all necessary background checks on my details, including qualification verifica-tion; the University to share my information with relevant authorities when requested by law; and further to share any personalinformation with relevant parties only with my express permission (in writing); permission to the University to share my results and statement of account with my sponsors, parents and/or USE BY UNIVERSITY ( ACADEMIC FACULTY) ONLYA pprovedRejectedIf conditional, give reason:Conditional SymbolConditional Senior CertificateSMAr t 44 AgePsychometric TestSignature of Dean/Head of DepartmentDateDMYEARR emarks:Speex TestSAQA EvaluationPART ESPORT & HOBBIESPART FDECLARATIONDMYEARDateSignature of studentIf Minor Signature of parent/guardianDateDMYEAR34 Indicate your interest with an X.