BELLVILLE CAMPUS

APPLICATION FOR RE-ADMISSION

YEAR

STUDENT
NO.

PLEASE COMPLETE THE INFORMATION BELOW IN FULL. YOUR ARE REQUIRED FILL IN THE CORRECT
ADDRESS WHERE YOU WILL BE RESIDING DURING THE VACATION PERIOD.

SURNAME: ____________________________________ FIRST NAME(S): _________________________________

POSTAL ADDRESS: ______________________________________________________________________________

_________________________________________________POSTAL CODE: _____________

CONTACT NUMBERS: __________________________________ (Cell) _______________________________ (W)

____________________________________ (e-mail)

RE-APPLICATION FOR: (Mark with an X where applicable)

JANUARY TO JUNE (SEMESTER 1) JULY TO DECEMBER (SEMESTER 2)

Level 2 Level 2
Level 1 (Experiential Level 3 BTECH Level 1 (Experiential Level 3 BTECH
Learning Learning)
S1 S2 S3 S4 S1 S2 S3 S4

NOTES: 1. Students who have previously registered in this Department should only complete this form.
2. Students will only be registered for subjects that do not have class and examination timetable
clashes.
3. Your acceptance remains conditional until confirmed by the Department.
4. The Residence Department administers student accommodation; therefore it is advisable to
contact them directly.

SIGNATURE: STUDENT ________________________________________ DATE: ____________________________________