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Address:
Nelson Mandela Drive, Mahikeng, 2735
call us:
+27(0)183862222
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Enrolment Form
Surname
*
Full initials
*
Title
ID
*
Date Of Birth
*
Student name
*
Full names
*
Occupation
*
RSA citizen
*
yes
no
If you are not a South African Citizen complete the following 6 fields:
Country code
Citizen resident status
Immigration date
Passport number
Alternative ID number
ID Type
Gender
*
Ethnic group
*
Marital status
*
Maiden name
Car registration
Transport type
Accommodation required
Mother tongue
*
Religion
*
Your Tel no
*
Your Cell no
*
Your Fax no
*
Your e-mail
*
Website
Academic postal address & postal code
Financial postal address & postal code
General postal address & postal code
*
Student type
*
Private
Employer
Bursary
Contact Info - If an Employer or Bursary
Academic postal address & postal code
Financial postal address & postal code
General postal address & postal code
Exam language
Apprentice
Yes
No
Course
Campus
FetMis information
Secondary education
*
Matric aggregate8
Previous year activity
*
Student support status
Disabilities
Medical information
Contact person
*
Relation
*
Contact no
*
Medical fund name
Primary member
Blood type
*
Medical doctor
*
Doctor tel no
*
Agreement
*
Applicant:
Parent/Guardian:
I hereby declare that the before mentioned information on this form is accurate and correct and should I, the applicant, be accepted as a student, I will unconditionally adhere to the rules and regulations of this college (in the case where the applicant is a minor, the agreement by the parent/ guardian will be binding):
Signature
*
Applicant:
Parent/Guardian:
I furthermore declare, I understand and agree, that by clicking on the Submit Your Form button below, this form is regarded as being signed by:
Security Code:
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Mmabatho
25
°
scattered clouds
humidity: 57%
wind: 6m/s N
H 22 • L 21
31
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Sun
31
°
Mon
30
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Tue
32
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Wed
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CONTACT INFO
Physical Address:
Nelson Mandela Drive, Mahikeng, 2735
Postal Address:
Private Bag X35, Mmabatho, 2735
Tel:
+27(0)183862222
Fax:
+27(0)183862100
Admissions-mhs@nwptb.co.za
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