Online Academics

APPLICATION FORM

* Required - Do not leave Blank

PART I – PERSONAL DETAILS (To be completed by applicant in Capital Letters)

Grade 12 School Certificate("PDF")*

Teachers’ Diploma OR Certificate (serving Teachers) ("PDF")

National Registration Card (NRC)("PDF")*

Deposit slips of the non-refundable application fee("PDF")*

Any other relevant documents("PDF")

Surname*

Other Names*

Marital Status *

Date of Birth *

Place of Birth *

Nationality (Select Country *)

Gender*

Identity*

Are You Physically Challenged (disabled) or not.*

APPLICANT Address (P.O. BOX and NOT physical address)*

E - Mail *

Phone*

Name of Applicant’s next of Kin *

Your relationship with the next of Kin *

Address of Next of Kin (P.O. BOX and NOT physical address)*

Next of Kin’s Mobile Contact*

PART II – EDUCATIONAL BACKGROUND (To be completed by applicant in Capital Letters)

NO.	SUBJECT	GRADE	YEAR
Indicate the Secondary School Certificate Results below (BEST FIVE SUBJECTS ONLY) (GRADES 1 – 6 INCLUDING ENGLISH) *
1
2
3
4
5

Are you a Special Education Trained Teacher?*

Declaration and undertaking

I declare that all the information provided by me on this form is true and correct to the best of my knowledge,

and I undertake to comply with the rules, regulations and decisions of the University College.