UNIVERSITY OF NAMIBIA Private Bag 13301, 340 Mandume Ndemufayo Avenue, Pioneerspark, Windhoek, Namibia

APPLICATION FORM YEAR: 2022

DEPARTMENT OF LANGUAGE
DEVELOPMENT
ACCESS COURSE
(Full time: year course-Feb until Nov)
COMMUNICATION & STUDY SKILLS
Tel:+264-61-206 3885 /206 3940 Fax :+264-61-206 3943 www.unam.na/centres/language_centre/index.html

A. PERSONAL DETAILS
Title: Mr Mrs Miss Dr Prof Rev
Surname:

Initials: First Name(s)

COURSE: FIRST CHOICE:

(After Completing EAC)

CAMPUS: SECOND CHOICE:

(After Completing EAC)

B. ADDRESS

Postal Address:

Residential Address:

Telephone number (H): Telephone number (W):

Cellphone number: E-mail Address:

FOR OFFICE USE ONLY

LEVEL:
ENGLISH INTENSIVE - ELEMENTARY
ENGLISH INTENSIVE - INTERMEDIATE
ENGLISH INTENSIVE - ADVANCED
ENGLISH FOR MULTI-PURPOSES LEVEL 1
ENGLISH FOR MULTI-PURPOSES LEVEL 2
ENGLISH FOR GENERAL
COMMUNICATION (TAILOR MADE)
C. PERSONAL PARTICULARS
Date of Birth: Gender: Male Female

I.D. Number Marital Status:

Passport No.: Home Language:

Occupation: Home Town:

Nationality:

D. EDUCATIONAL DETAILS
Highest qualification obtained:

Institution where obtained:

Medium of instruction:

Date obtained:

E. DECLARATION

I declare that the above information provided is true and correct.

SIGNATURE: DATE: D D M M Y Y Y Y

FOR OFFICE USE ONLY:

Course:
Venue: Days:
Officer Time:

Registration: N$ Receipt No.: Date:

N$ Receipt No.: Date:
N$ Receipt No.: Date:
N$ Receipt No.: Date:
N$ Receipt No.: Date:

Attendance CA marks EX marks FM marks

Certificate Issued: Yes: No:
COMMENTS:

SIGNED: DATE: D D M M Y Y Y Y

HAND DELIVERY TO ANY CAMPUS OF YOUR CHOICE

Applicants with Student Numbers Only!