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STUDENT ENROLMENT FORM
* denotes a required field
Surname*
Full initials*	Title:
ID*
Date of Birth*	Day: Month: Year:
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
Medical fund number
Primary member
Blood type*
Medical doctor*
Doctor tel no*

Agreement*	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): Applicant: or Parent/Guardian:
Signature*	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: Applicant: or Parent/Guardian:
*Security Code:**	Please enter the code: here: (to limit SPAM).