Learner Registration

Learner Registration Form

Complete all applicable fields. Fields marked * are required.

Section A — Personal Details

Title *

Initials

Surname *

Name/s *

Maiden Name

Citizen Status *

Nationality

South African ID Number

Alternate ID Number (Foreigner)

Date of Birth *

Alternate ID Type

Contact Number *

Alternate Number

Email Address *

Home Language *

Physical Address *

City / Town *

Municipality

Province *

Postal Code

Area Type

Postal Address (if different)

Next of Kin *

Next of Kin Contact Number *

Relationship to Applicant *

Do you have a Disability? *

Type of Disability (if Yes)

Socio Economic Status *

Occupation

Years in Occupation

Work Experience (Years)

Section B — Education

Highest Grade Passed *

Year Last School Attended

Last School Attended

Mathematics Taken?

Mathematics % / Symbol

1st Language

1st Language % / Symbol

2nd Language

2nd Language % / Symbol

Other Subject

Other Subject % / Symbol

Tertiary Education

Qualification 1

Year

Institution

Qualification 2

Year

Institution

Section C — Programme Selected

Programme *

Welder and Plumber are displayed for information but are not currently available for learner registration.

Declaration

I declare that all information provided in this registration form is correct to the best of my knowledge. I understand that false information may result in my registration being rejected. *

Applicant Full Name (Electronic Signature) *

Date *