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Bellville CampusP O Box 1906Symphony WayBELLVILLE 7535

Application for Advanced Studies

Cape Town Campus Mowbray CampusBellville Campus Granger Bay CampusWellington Campus

This form must be completed by all returning students who wish to apply for admission to post-diploma studies (i.e. NHD, BTech, MTech,DTech, etc.) Those applying to study at the Cape Peninsula University of Technology for the first t ime must complete the full application form.

COURSE NAME (Please indicate the full name of the course)

FOR WHICH YEAR STUDENT NUMBER TITLE INITIALS

SURNAME

IDENTITY NUMBER

FIRST NAMES

POSTAL ADDRESS

POSTAL CODE

ACCEPTED PROV. ACCEPTED NOT ACCEPTED WAITING LIST SIGNATURE DATE

FULL-TIME PART-TIME CODE (office use)

M

GENDERETHNIC GROUP AFRICAN COLOURED INDIAN WHITE

IF NOT A SOUTH AFRICAN CITIZEN, PLEASE TICK ONE OF THE OPTIONS BELOW

(A) AFRICAN (AFRICAN COUNTRIES (R) REFUGEE (N) PERMANENT RESIDENCE

(F) FOREIGN (OUTSIDE AFRICA (O) OTHER

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HOME PHONE NUMBER WORK PHONE NUMBER

FAX NUMBER CELL NUMBER

E-MAIL ADDRESS

POST-SCHOOL QUALIFICATION (S)

WORK EXPERIENCE

PLEASE NOTE THAT THIS FORM MUST BE ACCOMPANIED BY A COMPLETE ACADEMIC RECORD

LEGAL UNDERTAKING

I__________________________________________ I.D. NUMBER__________________________declare that all the particular supplied by me in this form are true, complete and correct. I accept that incorrect or misleading informationcould lead to the cancellation of this application

1. I undertake:

1.1 to comply with all the rules and regulations, including the disciplinary rules of the Cape peninsula University of Technology,including any amendments thereof as published from time to time and to acquaint myself with all the previous thereof.

1.2 to notify the Faculty Office immediately if I abandon my course of studies and/or change my address.1.3 To acquaint myself with and submit to all the rules and general regulations applicable to the course for which I wish to enrol

as well as the rules regarding to payment of fees.

2. I undertake that I will not hold the Cape Peninsula University of Technology liable nor make any claim against the University forcompensation and/or any expenses incurred or damages suffered as a result or in respect of any such damages, injury to meor illness or my death, i rrespective of whether such damages, injury or death may have been attributable to any degree ofnegligence on the part of the University or any or more of its employees or other person for whose actions it might, but for thisundertaking, have been responsible.

3. I am aware that my enrolment is valid only if it complies with the regulations governing the course concerned, notwithstandingthe acceptance of this enrolment by the University.

4. I accept that, if abandon my course of study at any time, no cancellation or reduction of fees will be considered andthat I will remain liable for the payment of all fees in full.

SIGNATURE OF APPLICANT________________________________________DATE___________________

TECHNIKON/UNIVERSITY DIPLOMA/DEGREE DATE OBTAINED

EMPLOYER POSITION EXPERIENCE & KEY TASK FROM TO

For Office use

This student complied with all the pre-requirements and can therefore be accepted.

Course Head.. Date

Head of De artment. Date