Tshwane University Sa of Technology REGISTRATION FORM FOR WORK We empower people INTEGRATED LEARNING (Wit) i instructions: [This form must be completed in full nd in CAPITAL LETTERS [A copy of the placement letter shouid be attached. This is a prerequisite for WIL registration. ‘STUDENT'S INFORMATION [Student Number initials I [Surname I Title [First Names [ fender | M]F i number [TUTALife e-mail address (No other please) (@TUTAlife.2c.za] [cellphone number(s) Residential lAddress during wit period lat Postal Code ACADEMIC INFORMATION (Please complete in full) [course Name | NOIP_| BTECH | L i [ [Course Code I [Subject Name I I LI I ]__ JBublect code EMPLOYER PLACEMENT INFORMATION (Please complete in full) [Name of approved employer L[ [111 Companyrcortctjenon | TEEPhysical address where training takes place Postal address where training takes place City Postal Code PERIOD OF STUDY (WIL) (Please tick the applicable block) PERIOD Tick TAST DATE FOR WIL REPORT TO BE SUBMITTED [January-June Bi July [February —July 31 August March - August 30 September [April - September 31 October May - October 30 November Lune - November 15 January July - December 31 January [August January 28 February [September - February 31 March, [October = March 30 April November Apri 31. May [December- May 30 June [Other: indicate the specific period of study e.g. 1st and/or 2nd semester (only applicable for faculties of the Arts, Humanities, Management Sciences and Economics) DECLARATION I declare that all information I have provided on this form are correct and | undertake to abide by the rules, regulations (Prospectus, Part 1 - Ch of student rules and regulations) and decisions of the Tshwane University of Technology, 2s well as any amendments applicable to students in general. Should | be registered Incorrecly as a result of incorrect informetion ‘that | provided,| accept full responsibility Signature: Student Date WIL registration approved by HoD: Yes NO Date Signature: Head of Department OR OFFICIAL USE ONLY ‘This form was captured by: Name (in block letters) Signature Date‘Tshwane University of Technology We empower people APPLICATION TO CHANGE YOUR CHOICE OF QUALIFICATION sdmission!2017 (HIGHER CERTIFICATE, NH CERTIFICATE, N DIPLOMA, DIPLOMA OR BACHELOR'S DEGREES) if you complete this form, ail previous qualification cholces will be cancelled, even if you have already been accepted in a qualification. Application for (year): Please submit this form with the following: + Aoatlfed copy of your ID or passport + Aezrtiied copy of you statement of symbols/Natlonal Senior Certeste + Email: sdmission@tutac.za + Please rote: you will only be considered for your 2nd choice if you have not besn selecied for your 1st choice, snd qualification concerned commodate addtional students al that stage. STUDENT NUMBER Clo ID or PASSPORT NUMBER CHOICE OF QUALIFICATION: Choice 1 |_| +] CHOICE OF QUALIFICATION: Choice 2 | Evening less [Fee ofenroiment: [Day cless Block course Do you require financial aid? | Yes No Campus: oo Soshanguve, GaRankuwa Polokwane ‘Mbombela ‘eMalahleni PERSONAL DETAILS: Tile: Initia: | Postal aacress | t L L | | [ T | Contact detail: | Hone phore | Cott phone number E-mail adress SIGNATURE OF STUDENT FOR OFFICE USE DATE NOT ACCEPTED SIGNATURE AND DEPARTMENTAL DATE STAMP MUST GO TROUGH SELECTION PROCESS ACCEPTED WAITING LIST ADMISSIONS OFFICE DATA CAPTURER ‘COMMENTS