INTERNATIONAL SCHOOL APPLICATION FORM

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YOUR CONTACT DETAILS

First names Surname

Title Mr Ms ID number
Mis Passport Number Date of Birth
s
ADDRESS FOR
POSTAL DELIVERIES

Postcode Country Use this address until /indefinitely

ALTERNATIVE OR NEW POSTAL ADDRESS (for DUT to use if letters are returned)

Postcode Country Use after until /indefinitely

EMAIL ADDRESS
For the attention of Address @ Use until /indefinitely
FAX NUMBER
For the attention of Code Number Use until
/indefinitely
PHONE NUMBERS Home Code Number Cellphone: For SMS messages

Should we use a different number to contact you during the day? Code Number
If we can contact you, is there another phone we can ring to leave a message for you?
Person to speak to Code Number

ABOUT YOURSELF
PREVIOUS SURNAME (if applicable)

COUNTRY OF CITIZENSHIP
What sort of South African permit/visa do you have?

Study Work

Permit not yet issued Permanent resident Please attach photocopy.

 Attach your documents inside the form

PLEASE PROVIDE THE FOLLOWING FOR STATISTICAL PURPOSE

Male Single/not currently married

Female Married

HOME LANGUAGE
English Spanish German Chinese Other

Which of the following best describes what you have been doing so far this year?

Degree Student Post-graduate student Working

Private College Student Student at a foreign tertiary Other (give details)

institution

APPLICANTS WITH DISABILITIES

Higher education institutions are sensitive to your needs. Please indicate if you have any conditions requiring assistance.

Blind Partially sighted Deaf Partially deaf Wheelchair

Crutches/callipers Paraplegia

Aliments requiring support Epilepsy Cerebral palsy

Psychological or learning difficulty

Other (give details)

HIGH SCHOOL ATTENDED

School name From To

International Education and Partnerships Office, website www.dut.ac.za,

School name From ToE-mail: International@dut.ac.za
School name From To
OTHER POST-SCHOOL EXAMINATION RESULTS Rewriting/upgrading

Year of exam Grade Level Symbol Grade Level Symbol

Subject

ARE YOU STUDYING NOW!

Date Qualification Student Qualification Awaiting
From To Institution Campus name/degree number complete result

Yes No Yes No
Yes No Yes No
Have you ever been excluded from a tertiary institution or a residence? If yes, year of exclusion
Institution Details Yes No

HAVE YOU INCLUDED?

Copy of your identity document & passport

Academic record and certificate of good conduct (if you have already studied at a tertiary institution)

Copy of Study or Residence Permit

Please do NOT send us original documents.

(name and surname the undersigned applicant)

Declare that all the information supplied is true to the best of my knowledge and that none of the information required has been withheld.
I understand that this application cannot be processed until the payment of the application fee has been received and that the application fee is not
refundable. I understand that institution apply selection procedures and that offer of places may be withdrawn if the conditions are not met or if
institution discover that I have provided false information in my application for admission, I undertake to submit to the DUT any documentation not
included with this form and copies of outstanding examination results, to inform the DUT of any change in address and to confirm in writing my
acceptance or refusal of any places offered to me,

Date Signature
Of applicant
Student’s personal social interests, e.g. sports, politics, community work, etc. Please write a personal narrative statement about your other
than academic interests. This will assist us when planning both your Service Learning placement and the group’s extra-curricular activities.

Attach Photo of
yourself

E-Mail the completed form to:

Durban University of Technology, e-mail: international@dut.ac.za