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1 Private Bag X6001 Potchefstroom South Africa 2520 Tel: 018 299 1111/2222 Web: http://www.nwu.ac.za School of Psychosocial Health / Skool vir Psigososiale Gesondheid Department of Psychology / Departement Sielkunde MASTER’S DEGREE IN CLINICAL/COUNSELLING PSYCHOLOGY FOR 2020 (Afrikaans volg) The above degrees covers the broad spectrum of clinical and counselling psychology. It includes a wide variety of therapeutic approaches and counselling procedures, as well as courses in neuro-anatomy, neuropsychology, differential diagnosis, adult, child and adolescent pathology and therapy, and other professional and practice-orientated workshops. This course is offered only on a full-time basis. During the first year of study a research proposal, two case studies, four written papers and an oral exam are completed. Practical work during the first year includes observations at the Witrand Psychiatric Hospital and the Tshepong Psychiatric Hospital, work at various community sites, the Phelophepa Train, schools, the Institute for Psychology and Well-being and NGOs, psychometric evaluations, individual psychotherapy with all age groups, and the various facets of counselling work. Training is provided through lectures, workshops and demonstrations. After completion of the theoretical and practical part of the course, a dissertation in article or book format is required. A full-time internship (one year) is done after completing the coursework, and board exams are written after completing the research and dissertation. You must apply separately for the internship and board exam. Thereafter only the clinical psychologists have to complete one year of community service. Only candidates who achieved an average of at least 65% in the honours-degree examination will be considered for paper selection. Thereafter a comprehensive selection process follows, after which approximately seven students for M- Clinical and approximately six students for M-Counselling are selected from all applications. Applications close on Friday 28 June 2019 at 16:00. APPLICATIONS RECEIVED AFTER THE CLOSING DATE WILL NOT BE TAKEN INTO CONSIDERATION. Paper selection will be done and thereafter the final selection will take place from Tuesday 3 September 2019 to Friday 6 September 2019. You must be available on all four days of the selection process. If necessary, further relevant information will be sent to you after receipt of your application.

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Private Bag X6001

Potchefstroom

South Africa 2520

Tel: 018 299 1111/2222

Web: http://www.nwu.ac.za

School of Psychosocial Health /

Skool vir Psigososiale Gesondheid

Department of Psychology / Departement Sielkunde

MASTER’S DEGREE IN CLINICAL/COUNSELLING PSYCHOLOGY FOR 2020

(Afrikaans volg)

The above degrees covers the broad spectrum of clinical and counselling psychology. It includes a wide variety of

therapeutic approaches and counselling procedures, as well as courses in neuro-anatomy, neuropsychology, differential

diagnosis, adult, child and adolescent pathology and therapy, and other professional and practice-orientated workshops.

This course is offered only on a full-time basis.

During the first year of study a research proposal, two case studies, four written papers and an oral exam are completed.

Practical work during the first year includes observations at the Witrand Psychiatric Hospital and the Tshepong

Psychiatric Hospital, work at various community sites, the Phelophepa Train, schools, the Institute for Psychology and

Well-being and NGOs, psychometric evaluations, individual psychotherapy with all age groups, and the various facets

of counselling work. Training is provided through lectures, workshops and demonstrations. After completion of the

theoretical and practical part of the course, a dissertation in article or book format is required. A full-time internship (one

year) is done after completing the coursework, and board exams are written after completing the research and

dissertation. You must apply separately for the internship and board exam. Thereafter only the clinical psychologists have

to complete one year of community service.

Only candidates who achieved an average of at least 65% in the honours-degree examination will be considered for paper

selection. Thereafter a comprehensive selection process follows, after which approximately seven students for M-

Clinical and approximately six students for M-Counselling are selected from all applications.

Applications close on Friday 28 June 2019 at 16:00. APPLICATIONS RECEIVED AFTER THE CLOSING DATE

WILL NOT BE TAKEN INTO CONSIDERATION. Paper selection will be done and thereafter the final selection will

take place from Tuesday 3 September 2019 to Friday 6 September 2019. You must be available on all four days of

the selection process. If necessary, further relevant information will be sent to you after receipt of your

application.

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Should you be interested to apply, you must complete the following forms/documentation:

1. The official university application form with all the relevant documentation as required on the form. This form is

available at http://studies.nwu.ac.za/postgraduate-studies/higher-degree-admissions and must be submitted online.

NB: Please do not send these documents to the Department of Psychology.

2. The following documentation is required by the Department of Psychology and must be handed in at

building E8 room 129, or sent electronically to Ms Ronelle Lubbe ([email protected]) :

NB: Please do not send these documents to Admissions.

1. The application form of the Department of Psychology

2. Full academic record and degree certificates

3. Copy of your ID document

4. Proof on an official letterhead from the employer/institution where practical experience was gained, signed by

the employer

5. The names and contact details of two referees (NO REFEREE FORMS ARE REQUIRED)

6. A biographical self-reflection

7. A selection fee of R400. Please attach proof of payment.

The account details are as follows:

NWU Divers Bank: ABSA

Account no: 670 642 313

Branch code: 632005

Reference: Surname/P-3B02154, e.g. Smith/P-3B02154

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. IT IS YOUR OWN RESPONSIBILITY TO ENSURE THAT WE

RECEIVE YOUR APPLICATION BEFORE THE CLOSING DATE, AND THAT YOUR APPLICATION IS COMPLETE.

If there are any enquiries please feel free to contact us at 018 299 1784.

Kind regards

Mrs Heleen Coetzee / Dr Tertia Oosthuizen

Programme Administrators: MA/MSc (Clinical and Counselling Psychology)

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Private Bag X6001

Potchefstroom

South Africa 2520

Tel: 018 299 1111/2222

Web: http://www.nwu.ac.za

School of Psychosocial Health /

Skool vir Psigososiale Gesondheid

Department of Psychology / Departement Sielkunde

MAGISTERGRAAD IN KLINIESE EN VOORLIGTINGSIELKUNDE VIR 2020

Bogenoemde g rade dek die breë spektrum van kliniese en voorligtingsielkunde. Dit sluit ’n wye verskeidenheid

terapeutiese benaderings en voorligtingprosedures in, asook kursusse in neuroanatomie, neuropsigologie, differensiële

diagnose, volwassene-, kinder- en adolessentepatologie en -terapie, en ander professionele en praktykgeoriënteerde

werkswinkels. Hierdie kursus word slegs op ’n voltydse basis aangebied.

Gedurende die eerste studiejaar word ’n navorsingsvoorstel, twee gevallestudies, vier skriftelike eksamenvraestelle en ’n

mondelinge eksamen afgelê. Praktiese werk sluit in observasies by Witrand Psigiatriese Hospitaal en die Tshepong

Psigiatriese Hospitaal, werk by verskeie gemeenskapsinstansies, die Phelophepa Trein, skole, die Instituut vir

Sielkunde en Welstand en NRO’s, psigometriese evaluering, individuele psigoterapie, kinderterapie, en verskeie fasette

van voorligtingswerk. Opleiding geskied deur lesings, werkswinkels en demonstrasies. Na afloop van die teoretiese en

praktiese gedeelte word die indiening van ’n verhandeling in artikel- of boekformaat vereis. ’n Voltydse internskap volg

(een jaar) na voltooiing van die kursuswerk. Na voltooiing van die navorsing en verhandeling word ’n raadseksamen

geskryf. Daar word apart vir die internskap en raadseksamen aansoek gedoen. Daarna doen slegs kliniese

sielkundiges ’n jaar gemeenskapsdiens.

Slegs kandidate wat ’n gemiddeld van minstens 65% in die honneurseksamen behaal het, word vir papierkeuring

oorweeg. ’n Omvattende keuringsproses volg daarna, waarna ongeveer sewe studente vir M-Klinies en ongeveer

ses studente vir M-Voorligting uit alle aansoeke gekeur word.

Aansoeke sluit op Vrydag 28 Junie 2019 om 16:00. AANSOEKE WAT NÁ DIE SLUITINGSDATUM ONTVANG

WORD, SAL NIE OORWEEG WORD NIE. Hierna volg ’n papierkeuringsproses, waarna die suksesvolle kandidate

uitgenooi word na die finale keuring, wat vanaf Dinsdag 3 September 2019 tot Vrydag 6 September 2019 plaasvind.

Alle kandidate moet vir die vier dae beskikbaar wees. Indien nodig sal verdere relevante inligting ná ontvangs van u

aansoek aan u deurgestuur word.

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Indien u belangstel om aansoek te doen, is dit belangrik dat u die volgende vorms/dokumentasie voltooi:

Die amptelike universiteitsaansoekvorm met die relevante dokumentasie soos aangedui op die aansoekvorm.

Die vorm is by http://studies.nwu.ac.za/postgraduate-studies/hoërgrade-administrasie beskikbaar en word aanlyn

ingedien.

NB: Hierdie dokumente moet nie na die Departement Sielkunde gestuur word nie.

Die volgende dokumentasie word deur die Departement Sielkunde benodig en moet by gebou E8 kamer

129 ingehandig word, of elektonies gestuur word aan Me Ronelle Lubbe ([email protected]) :

NB: Hierdie dokumente moet nie na Toelatings gestuur word nie.

1. Die Departement Sielkunde se aansoekvorm

2. ’n Volledige akademiese rekord en graadsertifikate

3. Afskrif van ID dokument

4. Bewys op ’n amptelike briefhoof van die werkgewer/instansie waar praktiese ervaring opgedoen is, en wat

deur die werkgewer onderteken is

5. Die name en kontakbesonderhede van twee referente (REFERENTVORMS WORD NIE BENODIG

NIE)

6. ’n Biografiese selfrefleksie

7. ‘n Keuringsfooi van R400. Bewys van betaling moet by die aansoekvorm aangeheg word.

Die rekeningbesonderhede:

NWU Diverse Bank: ABSA Reknr: 670 642 313

Takkode: 632005

Verwysing: Van/P-3B02154, bv. Smith/P-3B02154

ONVOLLEDIGE AANSOEKE SAL NIE OORWEEG WORD NIE. DIT IS U EIE VERANTWOORDELIKHEID OM

SEKER TE MAAK DAT ONS WEL U AANSOEK TEEN DIE SLUITINGSDATUM ONTVANG, EN DAT U AANSOEK

VOLLEDIG IS.

Indien daar enige navrae is, kan u ons gerus kontak by 018 299 1784.

Vriendelike groete

Mev Heleen Coetzee / Dr Tertia Oosthuizen

Programadministrateurs: MA/MSc (Kliniese en Voorligtingsielkunde)

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Private Bag X6001

Potchefstroom

South Africa 2520

Tel: 018299-1111/2222

Web: http://www.nwu.ac.za

School of Psychosocial Health/

Skool vir Psigososiale Gesondheid

Department of Psychology/ Departement Sielkunde

SECTION A: APPLICATION FORM / AFDELING A: AANSOEKVORM

ID/Passport

Photograph

ID/Paspoort foto

APPLICATION FOR ADMISSION TO THE MASTER’S COURSE IN

CLINICAL AND COUNSELLING PSYCHOLOGY FOR 2020

AANSOEK OM TOELATING TOT DIE MAGISTERKURSUS IN

KLINIESE- EN VOORLIGTINGSIELKUNDE VIR 2020

1 COURSE APPLIED FOR (Please

indicate / KURSUS WAARVOOR

AANSOEK GEDOEN WORD (Dui

asseblief aan)

2. GENERAL PARTICULARS / ALGEMENE BESONDERHEDE

Surname / Van

Full names / Volle name

Preferred name / Noemnaam

ID number / ID nommer

E-mail address / E-pos adres

Cellphone nr / Selfoonnr

Residential address / Woonadres

Postal address / Posadres

CLINICAL / KLINIES COUNSELLING/

VOORLIGTING

NO SPECIFIC

PREFERENCE /

GEEN SPESIFIEKE

VOORKEUR

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Single / Enkel Married / Getroud Divorced / Geskei Widowed/ Weduwee/Wewenaar

Afrikaans

English / Engels

Marital status /

Huwelikstatus

Number of dependent children /

Aantal afhanklike kinders

Linguistic ability / Taalvermoë

Good / Goed

Average / Gemiddeld

Poor / Swak

Afrikaans

English / Engels

African language (Specify)

Afrikataal (Spesifiseer)

Language preference / Taalvoorkeur

Member of Societies/Organizations / Verenigings of Organisasies waaraan u behoort

Hobbies/Leisure activities / Stokperdjies / Tydverdrywe

Psychiatric history: Do you have any psychiatric condition(s)? If YES, please provide details and treatment

/ Psigiatriese geskiedenis: Ly u aan enige psigiatriese toestand(e)? Indien JA, verskaf asseblief besonderhede

en behandeling.

Disabilities: Do you have any disabilities? If YES, please provide details and special support needed /

Gestremdhede: Het u enige gestremdheid? Indien JA, verskaf asseblief besonderhede en enige spesiale

ondersteuning benodig.

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Criminal record: Do you have a criminal record or have ever been found guilty of a criminal offence/ at a

disciplinary hearing? If YES, please provide details / Kriminele Rekord: Het u ʼn kriminele rekord of is u al ooit

skuldig bevind aan ʼn kriminele oortreding/tydens ʼn dissiplinêre saak? Indien JA, verskaf asseblief besonderhede.

3. ACADEMIC RECORD / AKADEMIESE REKORD

High school where matriculated / Hoërskool waar gematrikuleer

Matric subjects and symbols / Matriekvakke en simbole

Subject/

Vak

Symbol/

Simbool

University attended and degree(s) obtained (Please attach academic record and degree certificates to this

application) / Universiteit bygewoon en graad/grade behaal (Heg asseblief akademiese rekord en graadsertifikate

by hierdie aansoek aan)

University / Universiteit

Degree obtained / Graad behaal

Year / Jaar

4. WORK EXPERIENCE / BEROEPSERVARING

An official letter of proof from employer / institution where practical experience was gained, signed by the

employer.This must be handed in with your application form)./

(ʼn Amptelike brief van bewys van werkgewer / instansie waar praktiese ervaring opgedoen is, geteken deur die

werkgewer. Hierdie moet saam met u aansoekvorm ingehandig word)

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Name of employer /

Naam van

werkgewer

Capacity in which employed

and nature of work/

Hoedanigheid en aard van

werk

From / to

Tydperk

vanaf / tot

Reason for

resignation / Rede

vir bedanking

Contact details of

employer /

Kontak

besonderhede van

werkgewer

5. PREVIOUS / OTHER SELECTION / VORIGE / ANDER KEURING

Have you applied for Master’s selection at this university before? If yes, in which year?

Het u al vantevore by hierdie universiteit aansoek gedoen vir Magisterkeuring? Indien wel, watter jaar?

Have you apllied at any other university for Master’s selection for 2020? If yes, where?

Het u by enige ander universiteit aansoek gedoen vir Magisterkeuring vir 2020? Indien wel, waar?

6. REFEREES / REFERENTE

The names and contact details of two referees must be supplied, whereby at least one should be a former lecturer

in Psychology who taught you at honours level, or a Psychologist. The second can be an employer or any

Psychology lecturer. If on account of specific reasons you are not able to provide us with the details of a Psychology

lecturer, please attach a written motivation to this form /

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wees wat in u honneurskursus in Sielkunde vir u klas gegee het, of ʼn Sielkundige. Die tweede een kan ʼn werkgewer

of nog ʼn ander Sielkunde dosent wees. Indien u vanweë sekere spesifieke redes nie die besonderhede van ‘n

Sielkunde dosent kan verskaf nie, moet u dit in ʼn aparte skrywe motiveer en aan hierdie vorm aanheg.

Please provide particulars of the two referees: / Verstrek asseblief die besonderhede van die twee referente:

Title/Titel Name and Surname /

Naam en van

Address and e-mail address /

Adres en e-pos adres

Telephone number /

Telefoonnommer

7. BIOGRAPHICAL SELF-REFELECTION / BIOGRAFIESE SELFREFLEKSIE

Please provide an in-depth biographical self-reflection of your life thus far, paying attention to both the positive

and negative aspects thereof. (Requirements: Font type Arial 10, length: minimum 1 ½ pages, maximum 2 ½

pages)

Skryf ‘n i n- d iept e biografiese selfrefleksie van u lewe tot nou, waarin u aandag aan beide die positiewe en

negatiewe aspekte daarvan skenk. (Vereistes : Font tipe Arial 10, lengte: minimum 1 ½ bladsye, maksimum 2 ½

bladsye).

NB : CHECKLIST : Please tick the appropriate block to make sure that your application is complete

KONTROLELYS : Merk asseblief die toepaslike blokkie om seker te maak u aansoek is volledig

University application form (Submitted online) / Universiteitsaansoekvorm (Aanlyn ingedien)

Departmental application form / Departementele aansoekvorm

Academic record and degree certificates / Akademiese rekord en graadsertifikate

ID document / ID dokument

Proof of employment/practical experience/ Bewys van werkservaring/praktiese ervaring

Personal details of referees / Persoonlike besonderhede van referente

Biographical self-reflection / Biografiese selfrefleksie

Proof of payment (Selection fee : R 400) / Bewys van betaling (Keuringsfooi : R400)

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SECTION B: INFORMED CONSENT / AFDELING B: INGELIGTE TOESTEMMING

(Afrikaans volg op bladsy 12)

INFORMED CONSENT TO M-SELECTION 2020

1. BACKGROUND:

It is expected of you to thoroughly read through this document. If there are any questions or queries with regard to

the content of this document you can direct it to the administrator of the Master’s program. If you are satisfied

that you understand the outlined process and its implications, you can undersign the document and continue with

the selection process.

2. ADMISSION:

2.1 The yearbook of the Faculty of Health Sciences states the admission requirements for the MA/MSc in Clinical

and Counselling Psychology as follows:

In addition to the general admission and selection requirements of the university, the following

requirements apply for the Psychology department:

a) An honours degree in Psychology or an applicable equivalent qualification is required;

b) A paper selection based on academic performance and relevant skills will be conducted;

c) A formal selection process based on psychometric evaluation, an individual in-depth interview by a panel

of psychologists, a research assignment, evaluation of traits, skills and potential by means of case studies

and group work will be conducted;

d) A final in-depth interview by a selection panel of internal and external psychologists (departmental and

internship representatives) will be conducted.

(e) The results of the psychometric evaluation will be used during the final individual interview as background.

There will be no individual feedback to candidates regarding the psychometric evaluation.

(f) The School for Psychosocial Health is committed to provide a teaching and learning environment that is

welcoming, supportive, and accessible to all participants, regardless of ethnicity, culture, nationality,

language, disability, gender, sexual orientation, or religion, and to ensure that all students have an equal

opportunity for academic success. Our commitment is extended during this selection process.

2.2 The faculty can deny a student admission to a curriculum if the student’s standard of competence achieved in

previous applicable modules is not sufficient.

2.3 It is the responsibility of the student to:

a) Acquaint themselves with the closing date and make sure that their applications are received in time. No late

applications will be accepted.

b) To ensure that their applications are complete. No incomplete applications will be considered.

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c) Acquaint themselves with the dates and times of the formal selection procedure.

d) Acquaint themselves with the result of the paper selection as well as the necessary follow-up dates

and requirements.

3. SELECTION PROCEDURE:

a) To be part of this process the official University application form as well as the departmental application form

must be completed.

b) After the closing date the applications are processed and a panel is compiled to do the paper selection.

c) After the completion of the paper selection the successful candidates are informed that they were selected for

the formal selection procedure from Tuesday 3 September 2019 – Friday 6 September 2019. If the student

doesn’t receive any correspondence from the Department of Psychology with regards to the result of the paper

selection, it is his/her own responsibility to find out whether they were successful in the process of paper selection

or not.

d) After the completion of the formal selection process, the final successful candidates are announced. Opportunity

is given to the students to indicate whether they accept the selection or not.

e) The university is not compelled to fill the spaces if any of the selected candidates indicate that they are not taking

up their selected place. The Program coordinators can use their own judgment and in collaboration with the

selection panel decide to fill the vacant positions.

----------------------------------------------------------------------------

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INGELIGTE TOESTEMMING TOT M-KEURING 2020

1. AGTERGROND:

Daar word van u verwag om hierdie dokument deeglik te bestudeer. Indien daar enige vrae is, kan u dit aan die

administrateur van die Meesters program rig. Indien u egter tevrede is en verstaan wat die proses behels, kan u

dit onderteken en met die keuringsproses voortgaan.

2. TOELATING

2.1 Die jaarboek van die Fakulteit Gesondheidswetenskappe sit die toelatingsvereistes vir die MA/MSc Kliniese of

Voorligtingpsigologie soos volg uiteen:

Bykomend tot die algemene toelatingsvereistes van die Universiteit geld die volgende vereistes vir

die Sielkunde departement:

a) ‘n Honneursgraad in Sielkunde of toepaslike ekwivalent;

b) ‘n Papierkeuring met kriteria soos akademiese prestasie en relevante ervaring;

c) ‘n Formele keuringsproses wat bestaan uit psigometriese evaluering, ‘n individuele in-diepte onderhoud

deur ‘n keuringspaneel van sielkundiges, en ‘n navorsingstaak, gevallestudies en groepsprosesse vir

evaluering van sekere trekke, vaardighede en potensiaal sal gehou word;

d) ‘n Finale in-diepte individuele onderhoud voor die keuringspaneel bestaande uit interne en eksterne

sielkundiges (departement en internskapverteenwoordigers) word gehou.

e) Die resultate van die psigometriese evaluering word tydens die finale individuele onderhoude as

agtergrond gebruik. Daar word nie individueel aan die kandidate terugvoer gegee oor die psigometrie

evaluering nie.

f) Die Skool vir Psigososiale Gesondheid is toegewyd tot ‘n onderrig- en leeromgewing wat

verwelkomend, ondersteunend, en toeganklik is vir alle deelnemers ongeag etnisiteit, kultuur,

nasionaliteit, taal, gestremdheid, geslag, seksuele oriëntasie of godsdienstige oortuigings, en om te

verseker dat alle studente ‘n gelyke geleentheid kry vir akademiese sukses. Hierdie verbintenis word

ook tydens die keuring benadruk.

2.2 ’n Fakulteit kan toelating tot ’n kurrikulum weier indien die standaard van bekwaamheid wat die voornemende

leerder voorheen bereik het in die module(s) waarin hy/sy verder wil studeer, nie aan die vereistes voldoen nie.

2.3 Die onus rus op u as student om:

a) Seker te maak van die datum waarop die aansoeke sluit en u aansoek dienooreenkomstig in te handig - geen

laat aansoeke sal aanvaar word nie.

b) Seker te maak dat u aansoek volledig is – onvolledige aansoeke sal nie oorweeg word nie.

c) Seker te maak van die datums en tye van die formele keuringsproses.

d) Uself te vergewis van die uitslae van die papierkeuring sowel as die nodige opvolgdatums en vereistes.

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3. KEURINGSPROSES

a) U moet die amptelike Universiteitsaansoekvorm sowel as die departementele aansoekvorm voltooi.

b) Na die sluitingsdatum word die aansoeke verwerk en ‘n paneel word saamgestel om die papierkeuring te hanteer.

c) Na afhandeling van die papierkeuring word die suksesvolle kandidate ingelig dat hulle gekeur is vir die formele

keuringsprosedure vanaf Dinsdag 3 September 2019 – Vrydag 6 September 2019. Indien u geen

korrespondensie van die Sielkunde department ontvang rakende die uitslag van die papierkeuring nie, is dit u eie

verantwoordelikheid om seker te maak of u suksesvol was al dan nie.

d) Na afloop van die formele keuringsproses word die suksesvolle kandidate aangekondig, en hulle word die

geleentheid gegee om aan te dui of hulle keuring aanvaar al dan nie.

e) Daar is geen verpligting op die Universiteit om verdere kandidate aan te wys indien daar persone is wat nie die

keuring aanvaar nie. Die programleiers mag hulle eie oordeel gebruik en in samewerking met die keuringspaneel

besluit om die vakante plekke te vul.

NB : ALL PERSONAL INFORMATION IS STRICTLY CONFIDENTIAL , BUT MAY BE MADE AVAILABLE TO

THE PANEL DURING SELECTION.

NB : ALLE PERSOONLIKE INLIGTING WORD STRENG VERTROULIK HANTEER, MAAR MAG WEL

BESKIKBAAR GESTEL WORD AAN DIE PANEEL TYDENS KEURING.

Hereby I, the undersigned, declare / Hiermee verklaar ek, die ondergetekende

1. That I read though the information outlined above and that I understand the content thereof / Dat ek bogenoemde

inligting deurgelees het en die inhoud daarvan verstaan.

2. That I had the opportunity to ask questions and to clarify any uncertainties with regards to the selection process /

Dat ek die kans gehad het om vrae te vra en onduidelikhede rakende die keuringsproses uit die weg te ruim.

3. That I give permission that any person can be contacted for further information regarding this application /

Dat ek toestemming gee dat enige persoon gekontak mag word vir verdere inligting in verband met hierdie aansoek.

4. That I accept the decision of the selection panel as final / Dat ek die uitslag van die keuringspaneel as finaal aanvaar.

Signature / Handtekening Date / Datum

Signature of witness /

Handtekening van getuie

Signature of witness /

Handtekening van getuie

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