APPLICATION FOR SHORT COURSE STUDIES

1 1 I n f o r m at I o n pa g e t o b e r e ta in e d b y t h e s t ud e n t APPLICATION FOR SHORT COURSE STUDIES Please read the instructions below before completing this APPLICATION form. APPLICATION procedure This APPLICATION form must be completed in full by all students who are applying for a SHORT COURSE at the Cape Peninsula University of Technology and certified copies of all supporting document must be enclosed. Once this APPLICATION form had been completed and the supporting documents are attached, it must be submitted to the COURSE administrator responsible for the SHORT COURSE that you will be attending. Consult the website to see which COURSE administrator to go to. Once your APPLICATION had been accepted and processed the COURSE administrator will issue you with a student number.

2 Document requirements The supporting documents listed below are documents to be submitted with your APPLICATION form. Ensure that certified copies are less than three months old. CPUT reserves the right to take legal action if documents are not authentic. A certified copy of the first page of your Identity Document/Card. Proof of your highest level of school education. International students must submit a valid study visa and proof of medical insurance for the duration of their STUDIES . Payment of fees SHORT COURSE fees are payable in full prior to commencement of date of the COURSE . Cash payments can be made at the Cashiers Office on the campus. Provide the cashier with your student number (that had been issued to you by the COURSE administrator) as reference when making payment.

3 Should you make payment by means of electronic payment transfer (EFT) proof of such payment has to be submitted to your COURSE administrator. If your employer is paying your COURSE fee and such employer is: A government department or parastatal - A letter must be obtained in which the employer commits to paying the COURSE fee - An invoice will then be sent to the employer by the COURSE administrator A company or other corporate entity - The employer pays the COURSE fee prior to the COURSE commencing or the applicant does so. - In the latter event the applicant then claims back the COURSE fees paid from his/her employer. 2 South Africa 100 Namibia 101 Zimbabwe 102 Lesotho 103 botswana 104 Swaziland 105 Mozambique 106 Angola 107 Zambia 108 Malawi 109 Any other African Country 121 Europe 131 Asia 141 North America 151 South America 161 Australia 171 If other, please specify: SHORT COURSE APPLICATION FORM STUDENT NO: COURSE APPLIED FOR: NAME OF THE SHORT COURSE CENTRE (CONSULT THE WEBSITE) TITLE SURNAME INITIALS ID NO / PASSPORT NUMBER FIRST NAMES DATE OF BIRTH (DD-MM-YY) IT IS A GOVERNMENT REQUIREMENT THAT WE ASK YOU TO COMPLETE THE FOLLOWING SECTION.

4 CROSS THE BLOCK NUMBER POPULATION GROUP CITIZENSHIP African 4 Coloured 2 Indian 3 White 1 Other 5 DISABILITY Yes No If yes, please indicate INDIVIDUAL/GOVERNMENT DEPARTMENT/PARASTATAL ADDRESS POSTAL CODE CELL NUMBER WORK NUMBER (include code) 3 EMAIL ADDRESS NEXT OF KIN CONTACT NUMBER RELATIONSHIP ( father, etc.) NEXT OF KIN NAME & SURNAME DECLARATION: I, The undersigned, declare that all the particulars supplied by me in this form are true, complete and correct. I accept that incorrect or misleading information could lead to the cancellation of this APPLICATION . I further undertake: 1. to comply with all the rules and regulations of the Cape Peninsula University of Technology, including any amendments thereof as published from time to time and to acquaint myself with all the provisions of such amendments.

5 2. to notify the centre that offers the SHORT COURSE immediately if I abandon the COURSE and / or change my address; 3. that I will not hold the Cape Peninsula University of Technology liable nor make any claim against the University for any compensation and / or any expenses incurred or damages suffered as a result or in respect of any injury to me or illness or my death, irrespective or whether any such damages, injury or death may have been attributable to any degree of negligence on the part of the University or one or more of its employees or other person for whose actions it might, but for this undertaking, have been responsible. 4. that I will remain liable for the payment of all fees in full if I abandon or change my COURSE at any time and accept that no cancellation or reduction of fees will be considered except where unforeseen circumstances or lack of sufficient enrolments may necessitate the cancellation of a COURSE .

6 SIGNATURE OF APPLICANT DATE OF APPLICATION (DD-MM-YY)