APPLICATION FOR ADMISSION TO THE ACCESS FOR SUCCESS PROGRAMME IN 2024

Presented by Academy for Environmental Leadership SA (Pty) Ltd

Closing date for applications: 2 February 2024
General:
This application is for provisional admission to the A4S programme. Should this provisional application be accepted,
you will be required to furnish further particulars. Your application will only be finally considered once you have
furnished us with your NSC certificate.

To qualify for admission to the Access for Success (“A4S”) programme applicants must:
• Be in grade 12 in 2022 or 2023;
• Have passed the National Senior Certificate with at least 40% for Mathematics;
• Have passed the National Senior Certificate with at least 40% for Physical Sciences;
• Have passed the National Senior Certificate with at least 50% for English as Home Language or First
Additional Language;
• Have passed the other subjects from the group of subjects designated for university admission with at least
50%;
• Have passed the National Senior Certificate with at least a 50% average (excluding Life Orientation).
Students with Mathematical Literacy will not be accepted.

What the programme offers:

The yearlong A4S programme offers you an opportunity to improve your Grade 12 Mathematics and Physical Science
marks if you are willing to work hard.

Selected learners embark on a one-year focused programme. Learners will receive 10 hours of tuition per week
(Mondays to Saturdays) in both Mathematics and Physics. The purpose is to improve learners’ scores in the National
Senior Certificate (Gr12) in these essential subjects to a level where they qualify for admission into an university to
prepare themselves for critically important occupations in STEM (science, technology, engineering, and mathematics)
professions. Due to time and logistical constraints, unless special arrangements can timeously be made which do not
interfere with the A4S programme or classes, learners will not be allowed to re-write any other subjects.

Academy for Environmental Leadership SA (Pty) Ltd is provisionally registered with the Department of Higher Education and Training until 31 December 2024 as
a private higher education institution in terms of Act 101 of 1997
Registration Certificate No 2021/HE07/003
Directors: Adv. J.A. le Roux SC, Prof. L. van Huyssteen
The Access for Success Programme is facilitated by The Academy for Environmental Leadership SA (Pty) Ltd 1
A4S_Form_ApplicationP1_2024_V1_2023.10.16.docx
It is in your own interest to ensure that this form is completed in full.
Applicant’s personal details:
Surname: _______________________________________________________
First names: _______________________________________________________
Gender: _______________________________________________________
Date of birth: _______________________________________________________

Applicant’s contact details:

Home address (street): _______________________________________________________
Postal address: _______________________________________________________
Postal code: _______________________________________________________
Mobile number: _______________________________________________________
Email address: _______________________________________________________

Parents’ or legal guardian’s contact details:

Name and surname of father ________________________________________________
Identity no: _______________________________________________________
Home (street) address: _______________________________________________________
Postal code: _______________________________________________________
Mobile number: _______________________________________________________
E-mail address: _______________________________________________________

Name and surname of mother ________________________________________________

Identity no: _______________________________________________________
Home (street) address: _______________________________________________________
Postal code: _______________________________________________________
Mobile number: _______________________________________________________
E-mail address: _______________________________________________________

Academy for Environmental Leadership SA (Pty) Ltd is provisionally registered with the Department of Higher Education and Training until 31 December 2024 as
a private higher education institution in terms of Act 101 of 1997
Registration Certificate No 2021/HE07/003
Directors: Adv. J.A. le Roux SC, Prof. L. van Huyssteen
The Access for Success Programme is facilitated by The Academy for Environmental Leadership SA (Pty) Ltd 2
A4S_Form_ApplicationP1_2024_V1_2023.10.16.docx
Where applicable name and surname of guardian ______________________________
Identity no: ________________________________________________________
Relationship to learner: ________________________________________________________
Home (street) address: ________________________________________________________
Postal code: ________________________________________________________
Mobile number: ________________________________________________________
E-mail address: ________________________________________________________

Secondary school attended

Name of secondary school: __________________________________________________
Address: __________________________________________________
__________________________________________________
Telephone number(s): __________________________________________________
E-mail address: __________________________________________________

Documents:
Please include certified copies of the following documents with your application:
• Identity document
• Your grade 12 September exam results and NSC grade 12 results when available in January 2024.

Your fully completed application form and supporting documents may be submitted in any of the following ways:
• WhatsApp: 066 5106628
• E-mail: info@access4success.co.za

Signed by applicant:
Done and signed on this ____________day of ________________________________(month) 2024.

_____________________
APPLICANT

Academy for Environmental Leadership SA (Pty) Ltd is provisionally registered with the Department of Higher Education and Training until 31 December 2024 as
a private higher education institution in terms of Act 101 of 1997
Registration Certificate No 2021/HE07/003
Directors: Adv. J.A. le Roux SC, Prof. L. van Huyssteen
The Access for Success Programme is facilitated by The Academy for Environmental Leadership SA (Pty) Ltd 3
A4S_Form_ApplicationP1_2024_V1_2023.10.16.docx
Important notice. Please note that the information furnished by you in this application form is personal information
as defined in the Protection of Personal Information Act 4 of 2013. By completing and submitting the application form
you consent to the collection and processing of your personal information. You may at any time withdraw your
consent, but this will invalidate your application.
Please note that the submission of this application form, duly completed, as well as compliance with the requirements
for admission to the A4S programme is no guarantee that your application will be successful. Admission is in the sole
discretion of the AEL.

Academy for Environmental Leadership SA (Pty) Ltd is provisionally registered with the Department of Higher Education and Training until 31 December 2024 as
a private higher education institution in terms of Act 101 of 1997
Registration Certificate No 2021/HE07/003
Directors: Adv. J.A. le Roux SC, Prof. L. van Huyssteen
The Access for Success Programme is facilitated by The Academy for Environmental Leadership SA (Pty) Ltd 4
A4S_Form_ApplicationP1_2024_V1_2023.10.16.docx