‘THIS FORM MUST ONLY BE PRINTED IN COLOUR. higher education & training PSL Department: Higher Education and Training REPUBLIC OF SOUTH AFRICA KING 11R6l) HINTSA APPLICATION FOR ACADEMIC ADMISSION 20. "NBII Please note that this is only an APPLICATION. Even if you have completed the form correctly and you comply wit the minimum entry requirements t oes not necessary mean that you have been accepted at KHC. We consider all applications and will inform you ofthe outcome. Pte eeee INSTRUCTIONS: ‘+ Use capa letters to complete ths frm or place an X inthe correct box. Please use a black pe. + Kindly complete the form in FULL and answer all the questions. Be ri National Certificate Vocational (NCV)- Year Report 191 Business Studies ~ Semester Business Sues /ngineerngToursm/Hospalty Primary Agicure Business Sues /nginoerng Tursm/HosptatyFarmin Report 191 Engineering Studies [ “Trester Pogranmne Centane [| Dutywa Teko [| Willowvale | rae 4 Full Names: Z Middle Name: T acto: [ETT RLY [S [SS] Se tie SE tel] eth pat . ats sey Bemis Ys |_| |Pomt ty ae) =] ast Ne | J Marital status: | ‘wares! | ~Dhereed[—] widowed Maiden Sumer: EEE Ethnic Group: wnte[—] colo other Home Language: Eee Contact Details: Meter Ld of TTT at Ades ‘re you employed? Yes| | _No|_| __Ifyes please rovde Company Name: contact Deas: 1 Disability: Blindness [| Cerebral Palsy [| Physical Disability | None} Deafness| | Autistic Spectrum Disorders| _ | Behavioural/Conduc Disorder| — | Partal sghtedness /Low Vsion| | Psychiatric Disorder|] Hearing Problem |_| Eolepsy[—] Speci Leming Osa] Ober Seed en] Panos nots thet your applaton Torn cannot ba processed you have not tinced te ralavant documents Plese Tncate boom arte copy of your 10 Cte academic record pole) carted copy of your Fasspor (or international sudets) Grade 9-12: Ceti copy of your highest shel Certified copy of parent/guardian ID Pager oraHOME ADDRESS (Not PO Box or Private Bag) Isereet Address fsuburb [Town Code POSTAL ADDRESS (Steet Address/PO Box Isuburd frown ‘Code Isurmame Tite Iname(s) Trials lib Number [PO Box / Private Bag Isreet Address [suburb frown ‘Code [Tel (Home) [Tel (Work) Ice [e-mail Address Relationship EMPLOYER CONTACT DETAILS ‘Special Needs Itevies/Heath Problems [Contact Person oe Tevcett Medical Fund Bund # Man Member " SP Doctor Dr. Tel Fukera ‘Secondary School Student University Student ‘Student at this TVET College ‘Student at another TVET College | Uniyersty of Technology LIIKNITCA Name of last institution attended: X Mint ‘SCHOOL QUALIFICATIONS POST SCHOOL QUALIFICATIONS IName of Schoo! IName of Institution Highest Grade Passed ‘satus rear Wear Highest level passed in the following subjects: Isdence [Mathematics [Mathematical Literacy JAccounting {Grade 12: }with Endorsement without Private NSFAS Bursary Bursary Company Icourse: ‘Academic Period Level (suasecTs LEVEL | FULL TIME | PARTTIME (ark tn x) | (ark with ‘Page 2 of 4PCa It bereby decare: 1. thatthe information provided by me onthe previous pages inthis appicaton form ite and coret; that 1 undertake as a prospective registered student of KHC to abide by al the ues and regulations ofthe Coleg, incuding ay amendments thereto and any substutons thee; that 1 undertake otto bing any at, of whatever kind agaist the College, or any erloyee of he Coleg, nor i any Way to hal the Colege lable fr ary damage or less whatever wich may incur or sufer personaly orn property of mine and whch rect or rect arses fam my participation ae a stunt a the Colege in any ‘acy, concerring my studs, traning, sport or recreation, however sac damage or loss may cme abut, and that wil partcpat in any such actvty on my own responstity and wil accept of my own ree wil the rk attached thereto; ‘hat authorise the Coleg nthe event of my requring urgent medal treatment to get appropriste medal assistance and tat accept responstity forthe payment of the costs thus cured ‘to conform t the student code of conduct and student scpiary procedure to payal ees oned by myst tothe callege to spp the colage wth fl and corect eformation on all documentation to notiythe cage mn witing and immediately nthe event of change’ adres and tlebhene number to notitythe cage in witing I am unable to complete my stutles uet ness to abe byte Soames Ss L, mnancanen KING JES cals eniegiinyiaomencan een th aa Z —| ” > 16, That Lapree thatthe cous evel tht! am ating for inbes. yer mr quafcatog end bates Signature of Student Signature of Parent's / Guardian if student is under es) | ee Se ae NC Newspaper adverts) From Career Expo] Facebook| Twitter) | ‘From Friends or Family Radio Advert From the iteret (website) From community leader Pastor From Scho! guidance teacher | Open Dey | Visto School by KHC staff) | Other | )SSIBLE) © Private Bag x1082, Butterworth, 4960 KiKing Hintsa TVET College ‘$B Tel: 047 401 6400 1 Fax: 047 401 6432 yoww.kinghintsacollege.edu.za Page 3 of 4Pc 1. A registration fe as determined by the College Governing Boys payable a the begining fa couse tem. ls. No changes o subjects il be accepted after 10 working do of commencement of doses. lasses are abandoned or cancsed fr no very sound reason as stpulstad in condo 5, the fl ution fe payable. I. Studene who attend cases havea period of two days after publatio ofthe examination rests todo any adusents tothe enoiments ls. tn acaton tothe aforementioned the student andor paren and natural curd where application hereby concent to any lgal ato being neues or ecovering of oustanding fess nthe magistrates cout. [Inthe event of any couse fees beng oustanding the Coege shal ints sole dscretin be ented to refuse admission to any defen to the fina examination athe end ofthe sa course term. ls. 20% cass attendance and prescribed minum term mars are compulsory fr each Subject order to ganado tothe fal examination a the end ofthe sad Jo. students must submit proof of RSA Identfcaton Number or Stay VISA) and previous academic successes 10. 104C must be formed in writing of any adress changes frou are that we may: J) vert rormaton provided by you; Jb) _Seskinformaton fiom any credit bureau when assessing your application fe ny tme during your continuing indebtedness to us incding tracing or «cofrming your whereabouts x lo) Disclose the exstence of your account to any cre bureau, sharing bth pastve and negative payment infomation about such account Jretnemoe yu ht we wil be ene chan and dace te abo evomatn: be J+ we consider hat ts necessary or may be of benef oyu; a E J+ where we are uncer legal bigation to do so; ‘SIGNATURE OF STUDENT are KING 9 -..HINTSA [me completed aplation form cy signed by the above student and where applicable, parent or egal aus represents the Yormal Sac of enrlmer with King Hits [TVET Colge subject othe codons refered to above. SIGNATURE OF PARENT / GUARDIAN Gta es lsvupenr numBER | i | APPLICATION ACCEPTED! | APPLICATION REJECTED! | lpace nesutrs EVIDENCE OF NSFAS APPLICATION lcenrirte0 covits oF: ID / PASSPORT HIGHEST QUALIFICATION | _—_- PREVIOUS ACADEMIC RESULTS ‘SIGNATURE OF ADMISSION OFFICIAL (KHC) NAME AND SURNAME SE SIGNATURE OF ITS CAPTURER (KHC) NAME AND SURNAME DATE Physical Address: 218 Mthatha Road | N2 Postal Address: Private Bag X3018 | Butterworth | 4960 Page 4of 4