Application Form (Tertiary studies) Applicant Full Name/s and Surname: Preferred name: Physical Address Cellphone – Student* Postal Address Cellphone – Parent* Email Address:Please make sure that the contact details listed here are accurate and available at all times. The institution will be making use of the above-listed details as main line of communication. My suggestion would be to create a new gmail account for correspondence purposes. It is imperative that no communication gets lost in a SPAM folder or is missed because of many emails to the same account. Create jamesvarsity25@gmail.com for example. Date Of Birth ID Number GenderMaleFemale School Age Birth Place Race Grade NSC / IEB / CAMBRIDGE / OTHER: Home Language Other Language/s Have you already matriculated?List your Grade 11 subjects and your Promotion / year mark*One per line use (SHIFT+ENTER KEYS) to go to next line Do you have any disabilities OR health related issues? Medical aid and membership number Are you a South African citizen? Are your parents and/or sibling/s in any way associated with any University? What is your church denomination? WHAT PROGRAM/S OR QUALIFICATION/S ARE YOU APPLYING FOR?Stellenbosch Stellenbosch – 1st Choice Stellenbosch – 2nd Choice Stellenbosch – 3rd Choice WITS WITS – 1st Choice WITS – 2nd Choice WITS – 3rd Choice NWU – POTCHEFSTROOM NWU – 1st Choice NWU – 2nd Choice UP – PRETORIA UP – 1st Choice UP – 2nd Choice UFS – BLOEMFONTEIN UFS – 1st Choice UFS – 2nd Choice UCT – CAPE TOWN UCT – 1st Choice UCT – 2nd Choice Other 1 Other 1Name the Institution if not listed above Other 1 – 1st Choice Other 1 – 2nd Choice Other 2 Other 2Name the Institution if not listed above Other 2 – 1st Choice Other 2 – 2nd Choice Other 3 Other 3Name the Institution if not listed above Other 3 – 1st Choice Other 3 – 2nd Choice Other 4 Other 4Name the Institution if not listed above Other 4 – 1st Choice Other 4 – 2nd Choice Do you need housing on campus? Please list your choice of hostel/s at the various institutions. If you are unsure, please indicate that you need assistance.Institution 1 Institution 1 Institution 1 – 1st Choice Institution 1 – 2nd Choice Institution 2 Institution 2 Institution 2 – 1st Choice Institution 2 – 2nd Choice Institution 3 Institution 3 Institution 3 – 1st Choice Institution 3 – 2nd Choice Institution 4 Institution 4 Institution 4 – 1st Choice Institution 4 – 2nd Choice Institution 5 Institution 5 Institution 5 – 1st Choice Institution 5 – 2nd Choice Parent/Guardian Information: FATHER (IF APPLICABLE) Full Name/s and Surname (Father) Address: ID Number: Email Address: Occupation Tertiary Qualification/s Name Of Institution Employer Contact details: Cell Contact details: Work Year Parent/Guardian Information: MOTHER (IF APPLICABLE) Full Name/s and Surname (Mother) Address: Occupation ID Number: Email Address: Tertiary Qualification/s Name Of Institution Employer Contact details: Cell Contact details: Work Year Extramural activities (briefly explain) Sport Leadership Culture Hobbies Final Grade 11 Report*Certified with a date Final Matric Results/Matric CertificateCertified with a date International Results/CambridgeCertified with a date ID Document (Student)*Front & Back – normal size (Certified with a date) ID Document (Father)Front & Back – normal size (Certified with a date) ID Document (Mother)Front & Back – normal size (Certified with a date) Stellenbosch – Proof of Payment Pretoria – Proof of Payment UCT – Proof of Payment WITS – Proof of Payment Submit