APPLICATION FOR

SHORT COURSE STUDIES

I n f o r m at I o n pa g e t o b e r e ta in e d b y t h e s t ud e n t

Please read the instructions below before completing this application form.

Application procedure
This application form must be completed in full by all students who are applying for a short course at the Cape
Peninsula University of Technology and certified copies of all supporting document must be enclosed. Once this
application form had been completed and the supporting documents are attached, it must be submitted to the course
administrator responsible for the short course that you will be attending. Consult the website to see which course
administrator to go to. Once your application had been accepted and processed the course administrator will issue you
with a student number.

Document requirements
The supporting documents listed below are documents to be submitted with your application form. Ensure that certified
copies are less than three months old. CPUT reserves the right to take legal action if documents are not authentic.
 A certified copy of the first page of your Identity Document/Card.
 Proof of your highest level of school education.
 International students must submit a valid study visa and proof of medical insurance for the duration of their
studies.

Payment of fees
Short course fees are payable in full prior to commencement of date of the course. Cash payments can be made at the
Cashiers Office on the campus. Provide the cashier with your student number (that had been issued to you by the
course administrator) as reference when making payment. Should you make payment by means of electronic payment
transfer (EFT) proof of such payment has to be submitted to your course administrator.
If your employer is paying your course fee and such employer is:
 A government department or parastatal
- A letter must be obtained in which the employer commits to paying the course fee
- An invoice will then be sent to the employer by the course administrator
 A company or other corporate entity
- The employer pays the course fee prior to the course commencing or the applicant does so.
- In the latter event the applicant then claims back the course fees paid from his/her employer.

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 SHORT COURSE APPLICATION FORM

STUDENT NO:

COURSE APPLIED FOR:

NAME OF THE SHORT COURSE CENTRE (CONSULT THE WEBSITE)

TITLE SURNAME

INITIALS ID NO / PASSPORT NUMBER

FIRST NAMES DATE OF BIRTH (DD-MM-YY)

IT IS A GOVERNMENT REQUIREMENT THAT WE ASK YOU TO COMPLETE THE FOLLOWING SECTION:

CROSS THE BLOCK NUMBER

POPULATION GROUP CITIZENSHIP

Any other African
African 4 South Africa 100 Swaziland 105 121
Country
Coloured 2 Namibia 101 Mozambique 106 Europe 131

Indian 3 Zimbabwe 102 Angola 107 Asia 141

White 1 Lesotho 103 Zambia 108 North America 151

Other 5 Botswana 104 Malawi 109 South America 161

Australia 171

If other, please specify:

DISABILITY
Yes No If yes, please indicate

INDIVIDUAL/GOVERNMENT DEPARTMENT/PARASTATAL ADDRESS

POSTAL CODE

CELL NUMBER

WORK NUMBER (include code)

2
EMAIL ADDRESS

NEXT OF KIN CONTACT NUMBER RELATIONSHIP (e.g. father, etc.)

NEXT OF KIN NAME & SURNAME

DECLARATION:

I,
The undersigned, declare that all the particulars supplied by me in this form are true, complete and correct. I accept that incorrect or misleading information
could lead to the cancellation of this application.
I further undertake:
1. to comply with all the rules and regulations of the Cape Peninsula University of Technology, including any amendments thereof as published
from time to time and to acquaint myself with all the provisions of such amendments.
2. to notify the centre that offers the short course immediately if I abandon the course and / or change my address;
3. that I will not hold the Cape Peninsula University of Technology liable nor make any claim against the University
for any compensation and / or any expenses incurred or damages suffered as a result or in respect of any injury to
me or illness or my death, irrespective or whether any such damages, injury or death may have been
attributable to any degree of negligence on the part of the University or one or more of its employees or other
person for whose actions it might, but for this undertaking, have been responsible.

4. that I will remain liable for the payment of all fees in full if I abandon or change my course at any time and accept

that no cancellation or reduction of fees will be considered except where unforeseen circumstances or lack of

sufficient enrolments may necessitate the cancellation of a course.

SIGNATURE OF APPLICANT DATE OF APPLICATION (DD-MM-YY)