of Technology Re 7 Seeman none jceipt number ° a ) phran nvr DOH NGEISEONLY detrei a ROO ‘THECLOSING DATES FOR APPLICATIONS ARE ASFOLLOWS: 1, 18 May for courses that startin July ofthe same year 2. 15 June for Correctional Services Management, Dental Technology. Medical Orthotics and Prosthetics Policing Pharmacy and Radiography, Road Traficand Municipal Police Management: Municipal and Traffic Policing, 3, 15 June forallinternationalapplicants 44 31 July for Agriculture: Animal Production, Agriculture: Commercial Mined Farming, Agriculture: Crop Production, Agriculture: Development and Extension, Analytial Chemistry, Architecture: Professional, Dental Assisting Biomedical Technology, Biokintic, Blotechnology, Business (Communication, Clinical Technology,Economic Management Analysis, Engineering: Civil (8 Tech's), Engincering: Chemical, Engincering: Metallurgical, Environmental Healt, Fire Technology, Geology, International Communication, journalism, Lagal Assistance, Nature Conservation, Nursing Ofiiating and Coaching Science, Project Management, Public Relations Management, Quality Sport and Exercise Technology, Somatology, Three-Dimensional Design, Veterinary Technology al quahiications inthe Arts Faculty and Education 5. 30 September oral other courses 6, Anon-refundable fe of R240 for application, and certified copies ofyour Identity document, Senior Certificate/Natlonal Senior Certiieate ‘and ll other relevant documents must accompany the completed application form, Ifyou pay the application fee lectronically at 2 hank, the proof of payment must accompany the application form 7, Latesappltations wile considered ifspaces available 8, Please complete the orm n BLOCK LETTERS and mark the applicable information with an X [Fic application fe can be deposited blorchand a= | iyouarcapplyingior admission only, completesection Aand page 10 0f (BSA BANK ACCOUNT NUMBER: 04 000 0003 the application form, inthe Reference column, pease illin your identity number. | ttyouare applying for admission and financial assistance, complete [send the deposit slip withthe application form, sections Aand Cand page 10 ofthe application orm, Please refer to theimportant information onthe back ofthis page | iryouareapplyingtor admission and residence, complete sections INB. Do not use this account number forany further payments ‘Aand B and page 10 of the application form. Wereyou previously registered at TUT, Technicon North Gauteng Technicon North West or Technicon Pretoria? Yes No fyes please indicate your student number: ai i Initials Please indicateifyou arcan international applicant: Yes No surname SECTION A Application for admission: 20 When would you liketo start with your course? Jan July selected programmes only) First choice of Study {Please note: You will only be considered for your second cholceifyou have not been Selected for your Ast choice,and only ifthe course concerned can still accommodateadditional students at that stage) Type proposed study Day classes Eveningctasses Full-time block Part-time block. Campus Pretoria Soshanguve, Ga-Rankuwa Polokwane Mbombela eMalahleni Second choiceof study Type of proposed study Day classes Evening classes Part-time block Campus Pretoria,Soshanguve, Ga-Rankua Moombela eMalahleni (ane Cade Block OT choice Choice? Paget a A 568593) 567028! Is6e396 91437! a, aa 1 |. GENERAL, Js inyour interest to submit the application formsas soon as possibleand not to wate until the closing date for applications. ‘This form must be completed by all newcomer students; ‘Ifyou were reistered at the Tshwane University of Technology for the previous academic term or part thereot you need not romplete this form agai, ‘Block letters and black ink must be used for completing this form Intl + Applicants in need ofaccommodation must also complete this form. * Theprescribed administration fee of R240 must accompany this form ands nt refundable «The potential of applicants forall courses willbe evaluated. 1 You may not submit more than one application form, I'you wish toalter your choice atalater stage, you must doso in writing, + Documents thatare sent by fax are not acceptable, but you may scan and e-mail the certified documents. Refer to section 11 conthis page «The processing otyour application willbe deayed.Ityou all to.complete this form in ul fyou alto attach all herequired documents, ify ou fal to enclose the administration fe, your application reaches the University after the relevant closing date + TheUniversity must be notified immediately ofany change of ‘Address after the submission ofthis application. «Thereference number allocated to you must be quoted inal further correspondence. + Should you ater having submitted this application decide not to ‘contindewith your studies or to changeyour course, you must notitythe Registrar of your decision immediately inwriting ‘TheUniversity retains theright to refuse any application without statingreasons «+ Allnon-South Arica citizens must submit a study permit before registration, Provisional acceptance does not Imply ‘exemption from this requirement + Applicants will be informed in separateletters whether their applications for admission, nancial assistanceand ‘accommodation were success - ADMISSION REQUIREMENTS. Consult the brochure ofthe faculty concerned to find out whether you ict theadmission requirements for your proposed study fel DOCUMENTS: Certified copies ofthe following documents must accompany each application: Allapplicants ‘identity document. Applicants for certificate diplomaand degree studies ‘Senior Certfiate/National Senior Certicate or equivalent {ualifiation. ‘+ Anacademicrecord in respect of studies at another tertiary ‘institution, Applicants for B Tech and postgraduate studies ‘Oficial proofthatall the requirements fora diploma or degree hhave been met. dscasas 6570291 4. CAMPUS ‘You must find out beforehand whether the course ofyour choice is actualy presented atthe campus you areapplvingfor. Your application willbe considered only inrespect ofone campus. Ifyou areaecepted fora course, such acceptance apples only to the campus, concerned and tis not transferable 5. UNIVERSITY RESIDENCES Accommodation n residences is available ony in eMalahlent Ga ‘Rankuwva, Mbomibela, Soshanguve and Pretoria, and only for bona ide day-class students, 6. AWARDING OF STATUS Prospective students who obtained qualifications at other higher ‘education institutions must apply on the prescribed application form tobegrantedacertan status for further studies atthe Tshwane University of Technolo. 7. RECOGNITION OF AND EXEMPTION FROM SUBJECTS younavealready obtained credit(s for acourseand/or subjects ata higher education institution, you could possibly qualify or ‘recognition ofthosestbjeets and/or exemption fom corresponding Subjects at the Tshwane University of Technology. You must submit your application in this regard on the preseribed form, 8, SUBMISSION OF APPLICATIONS Your application anda correspondence must be sentto the campus here you intend studying. 9. LANGUAGE POLICY Inaccordance with the language policy ofthe Tshyrane University of ‘Technology the language medium for lectures i English. 110, LATE APPLICATIONS + Willonly be considered fspace is available + Applicants must establish whether space na coursels available before submittingan application. 111, ADDRESSES PRETORIA Registra, Private BagX680, Pretoria, 0001 Staatsartillrie Road, Pretoria West, ‘Tel. 086 110 2422, faxO12 382 5114 Email admission@tutacza ‘MBOMBELA Repistrar, Private Bag 11312, Mbombela,1200 ‘Te.013 745 3500, fix013 745 3512 Esmall-admissionnel@tutacza POLOKWANE Repistrar, Private Bay X9496, Polokwane, 0700 ‘Te.015 287 0700, fax015 297 7609 E-small-admissionpol@tutacza (GA RANKUWA Registrar, Private Bap X680, Pretoria, 0001 ‘Te.086 110 2422, x12 382 5114 E-mailadmission@tutacza SOSHANGUVE Registrar Private BagX680, Pretoria,0001 ‘Te.086 110 2422, faxO12 382 5114 Esmall-admission@tutacza eMALAHLENI Repistrar,PO Box 3211, eMalablenl, 1035, ‘Te.013 653 3100, fax013 653 3101 -mall-admissionem@tutacza slissasos: Ta143zt—— ee surname Initials Tithe Mr Mrs iss br Prot eee eee) ee marie, pean DsteofBirth 1 1 Gender Mae Female entered corms eed cn English ‘Arkams\Engish Inidebte ea eared Sesotho fare ceed Tshivenda oa isa ‘Ifother, specity Tansvage Marita states singe rome) eee Widow) char ataton fone Eee Presbyterian ema ‘Apostolic (New) Lateran Seventh Day Adventist a Assembles ofGod Methodist, Johns catholic Baptist Mastin Pau Fath Mission Churchof Christ, sme supers Dutch Reformed er ieee Faith Misson Notpreparedo divulge Roman catholic Fullcospet omer Protestant Reformed churches SA tind Pentecostal Protestant on Cristian Charen te other plese ‘specify Poetry coloured Indian Naebele Norther Sotho oe aoe Southern Sotho ‘Swazi ‘Tsonga ‘Tswana as Venda Xhosa waite 2atu Citizenship Angola ere cements peer Botswana ‘Countries in North America* ‘Swaziland ae Countries in Aicat Countries in South Americat Comision As Lesotho Courier in Auta an Oceana? Malet Ziniaiore Countries in plese spec Tyot 154 ree De eee eae Refugee eee eee cee eee INI 1 00 HE Micessstecros0 a slesessslrores7t MlWE scnco10 vounsan sour torr Career exibition Former student Internet school visit ‘Aveyou currently employed? Yes Word ofmouth Social Media Open day Radio programme Guidance teacher\ Counsellor No Ifyeshow many years? WHAT IS YOUR PRESENT ACTIVITY BEFORE YOUSTART YOURSTUDIES? Collegeof nursing student Grade 12 learner FET college student Labour force IHyou arerepisteredas astudent, please giveus thename ofthe institution: \Witlyou apply for subject exemptions? Yes MEDICAL AID INFORMATION (Main Member deatils) ‘Name of medical ad Medical ad number Surname Identity Number Title Relationship to student? Father Mother — Ifother,pleasespecity Specify medical conalitions Do you make use ofa wheelchair? Have youbeen placed under administrativeorder by a court? Hasacourt order declared you mentally unt? PREVIOUS AND CURRENT TERTIARY STUDIES ‘Teche’ tralng cols Univers of testo stant University student ober Initials Yes No Ifyes,please specify type? Manual lectric yes No Myes,specify the date 1 ' Yes No Iyes,speciythedate 1 ' ‘Student Number Institution Name ofdegree / diploma Completed | Not | Datedegree | Year | Year Completed | was conferred | from | to "EXTRAMURAL ACTIVITIES indice larship positon and/or spot) and/or caluralacvlis you paripin ab he highs ve you lave rechad Cultural oir Debating Leadership as cpt Residence prefect Scoolprtest Dept ot pret pesespecty speciy “DISABILITY _tfyoutavea isa, bu cboosenooaseoseiton tis orm the Tehwane Universi at) ead preset resides Deputy ea prefet resides Deputy ea preter sport ‘ashy is under o oblpton tsa or accommodts you with rgd to that sbi. one earig ven wth sng) ae ammunition king ben sieht Vea Physical (moving standing aspingor tiple Specify fonher Specify mJ 668393) opatve (tuts in ewan) ‘tina behaviour pool) Pages Sport Stool Reyjoml—Provini!_—Natlomal colours caburs cours coburs lake cet Rugby Voeba Is6e396 91437! 3a FONE cee) a APPLICANT'S POSTAL ADDRESS Tel (H) EMail APPLICANT'S RESIDENTIAL ADDRESS (A post office box must not be indicated here) STUDY ADDRESS (aisaty known) PARENTS" ADDRESS iter prntsorpurdin) rather Stepfather Te(H) Mall Mother Stepmother surname Address Tel(H) Mall 667032! 393! a | TeL(w) TelL(w) Tew) Postal Code Postal Code Postal Code Title Postal Code Title Postal Code Pages Fax Initials Fax Initials Fax e396 91437!cuaraian Title Inials Surname Address Postal Code Fax Tel (H) TeL(W) alt Name school seended Province Examination number Highest grade passed Grade 11 Grade12 Finalexam year Final exam month MATRICSINCE2008 ‘Examination results Please indicate your results inthe table below. Ifyou do not have a National Senior Certiieate/statement of final results,y our school principal must certiy the correctness of your Grade 11 results ad thelatest Grade 12 results. Without this sigatureand the school Stamp, your application cannot be considered, Any alternations must be signed in fully the person who certifies yt marks ‘TYPE OF CERTIFICATE CurrentyGrate12 scAdmieson Bachelor scAdiesion None NscAdmisioncartieste NSCAdmission Diploma sp recess tal ti recep ard st Peco ae " " " El a eeeteeeteeed Agricultural Science Business Studies eee i rae a ge is acto Sus aD ee ig on Lang cmp soy spay Sates a eon pa ieee ‘ctatome case icon i sim stent ste sete rise eae ‘Sesotho Home ‘Setswana Home Language aw Language aed Toxin ‘hiv tone Linge: aungtone come Pessindate with which resus doyou Grades Wiacrate12 | FiatGrade12 a? MIL ' HM ME Wieses!seross a sessvoclrores7! | MlOTHER suBjects Percentage % Level Subject Name ay (Please complete with lack pen) (Name ofprineipal) Thepprineipa of. (ame oFsehoo!) Declare that the information on this pages correct and that It corresponds to the oficial school records. ons a MUAY . M00 ME ieccses!seroad a Jeesvoclrorss7! | MlOther Matric 91437! 6 e396a SECTION B a RESIDENCE APPLICATION Pease note that selecting "Yes" no guarantee of obtaining accommodation inaresidenc. Successful residence applicants willbe Do you want to apply for accommodation ina residence? Yes Tia re ee ea ee * oa SECTION C: DO NOT INCLUDE ANY SUPPORTING DOCUMENTS WITH THIS APPLICATION BUTI ape SIE} (Please note that selecting"Yes" doesnot guarantee financial assistance): You will ned to providesupporting document's to substantiate the below i er ley ee 222, | mtn mse i a wee | set | mee, | | Aint fool |] oe [TE | neat £ te) Deceased) ; 3 5 : 3 3 7 : 3 ‘Terms and Gonditions 1. This aplication will only be considered f= LL tis received beoretheelosing date of 15 November; 112 Theaboveinformation is completed full; 13 You have obtained admission to theuniversity; 414 After admission you haveto upload the supporting documents (ID, payslips ete) required to complete this application process (See web for details at wiww tutacza/ students /inanclal) 2.0nly South African Citizens will heconsidered for funding. 3.Only students enrolled for subsidized programs will beeligiblefor funding 4.Supportive documents and information provided above will be subject tothe qualification thatit may be verified (refertothe ‘Memorandum of Agreement on page 10). Note: Please follow up this application with your local Financial Aid Office before 30 November. Fromoutof own sying Pot otetrares “ype wise png (krone ak Stoning somewe 1) Tureen dleceses iN a retestMEMORANDUM OF AGREEMENT Should my application be successful 1, icclare that 1. Allparticulars given by mein this form aretrueand correct; 2. Lyvillaequaine myself with therules and regulations ofthe Tshwane University of Technology and willabide by them 2. Lill nform the Registrar immediately, in writing would | change ny adress or eancel or change my course or any subjects; 4. Tam aware that my enrolments valid only ifitcomplies withthe relevant regulations of he University; notwithstanding provisional ‘Seceptance ofthis enrolment by the University 5, Tam aware that fes and legal costs willbe recovered from me sould fit full! my financial commitments towards the University; 6, Thereby give consent tothe University andits subcontractors or ‘operators to collect and process my personal information for the purposes ofthis agreement provided such information s kept ‘confidential 7. ‘understand that subject to applicable laws and rules and regulations ofthe University, may access the personal information ‘TUT has about meby contacting the ofc ofthe Regstrar and if necessary request that corrections hemade: 8, I authorise the University to provide information relating tomy. studies and conduct while atthe University to other educational Institutions, my parents or legal guardian, y employer and my sponsors to enable such asponsor or hinder to determine the Continuation of suck sponsorship or funding: 9, ‘authorise the University to provideinformation relatingto my studies and conduct to potential sponsors or potential employers to enablesueh potential sponsor or potential employer to decide Whether to providerewith funding, training oF employment portunities; 10,1 grant the University permission to enqulreand verity my ‘qualifications already obtained in other Institutions 11, Trecord and warrant that Ihave obtained the information as requlred Insection Cofthis application form, directly from he household family members listed and that have thelr consent to ‘convey itto you and that you may verify such information. | verily believe that the information disclosed is trueand correct,and this. Information thus madeavallable whether disclosed or undisclosed FRsubjectto the qualification that it may beveried, with the understanding thatthe Financtal Aid Office will keep the information ‘confidential accept fll responsibility forthe payment ofall lass and/or residence fees as well as anyother fees determined by the ‘Tshwane University of Technology: 13, Laccept that my examination results/certificate/diploma/degree and ‘study records may be withheld under the following cireumstances: {@)Intheeventofmy student account beingin arrears, or () Inthe event ofany disciplinary matter pendingagainst me; 14, Thereby cede and transfer tothe University all rights and tittefn any Intellectual property reated by me during my course ofstudy or in any research project undertake athe University, unless otherwise agreed. F Signature of applicant: Date Herein assisted as faras may be necessary while theapplicant or stu dent is stillunder theage of eighteen years. 1, NT FIRSTNANESAND SORNAE) the undersigned, in my capacity of ____{parent or legal guardian) hereby admit that am tobe ointly and separately esponsible fr moneys,theabove applicant may at any stage owe the Tshwane University of Technology in terms ofthe agreement that he/she has concluded withthe University, as set out above,ineludingany alteration to such agreement. signature of parent or legal guardian Tshwane University of Technology INDEMNITY AGAINST CLAIMS FOR LOSS OR DAMAGES Reference number 1 full ‘name) the undersigned: hereby dedare that I (including my dependants) shal not institute any claim ofany nature whatsoever against the Tshwane University of Technology or any employee ofthe ‘Tshwane University of Technology, acting within his or her employment capacity, nor shall in any way whatsoever hold the ‘Tshwane University of Technology responsiblefor any loss or damage that | may suffer in person or in respect ofany property of ‘mine,or which may directly or indirectly arise from my commitment, asaregistered student, towards the Tshwane University of ‘Technology, resulting rom any act or omission whatsoever during ‘hell period of my tuition and/or practical, or during any sport activity that undertake, or duringany time that liveina residence of ‘the Tshwane University of Technology, or duringany trip of journey ‘that undertake to or from such residence oF tution oF practical ‘raining or with regard to any activities at practical traning location, ‘regardless ofthe way in which such loss of damage may occur and "regardless of who or what may be responsible. undertake to participate any stvity that |am expected to participate in, on my ‘own responsibilty, voluntarily takingon any risk may expose imyselfto in connection with any sich activity ‘hereby confirm that Iwill imeously acquaint myselfwithall the {information and rules in connection with practical training, and that am, asaregistered student of the Tshavane University of Technology, ‘bound to adhere to the General Rules and Regulations ofthe Tshwane University of Technology | understand thatthe terms and conditions ofthis indemnity sh ‘remain n force for the duration of my studies atthe Tshwane University of Technology. ‘furthermore declare that in case Lam injured in such amanner that cannot personaly give consent to any medical treatment or medical intervention that may bein the direnced of,the supervisory staff ‘may sign the necessary letters ofconsent on my behal ‘Thus signedat. fonthis__dayof___20_ Student's signature Signature of parent/guardian, applicable: (stadentisaminory ‘CHECKLIST © Did you iin thename ofthe qualification you areapplying for? 1 Ifyou previously studied at another higher education institution, hhaveyou attached your academic record? 1p Didyou state the level of your school subjects, eg. English Fist Language? 1 Did yousign the Memorandum of Agreement? © Ifyowareunder 18 years of ag, did your parent/guardian sign the Memorandum of Agreement form as well? 1 Didyouenclose the administration fee of R2402 © tfalready matriculated, did you attach acerttid copy ofyour Senior Cetiicate/National Senior Certineate evaluation? 1 Didyou take note ofthe Language Policy? © Did you sign the indemnity form? 1 Certified copy ofyour1D/passport attached? 1 Didyouiindicateyour need for financial aid? 1 Did you indicate your need for accommodation? Page 10 Is6e396 91437! 3