empl id: 2019 application for … · 2019 application for undergraduate admission ... certificate...

2019 APPLICATION FOR UNDERGRADUATE ADMISSION

2019 APPLICATION FOR UNDERGRADUATE ADMISSION

• Apply online. Use this booklet only if you do not have access to the internet.• If you are currently registered at UCT, and wish to transfer to another undergraduate programme, you must consult the Faculty that you wish to transfer to.• Complete this form using the information and codes found in the 2019 Directions for Undergraduate Applicants.• Please complete this form in CAPITAL LETTERS in ink.• Return this completed form by post or in person. This form must not be faxed or emailed.• DO NOT submit your application fee with this form. Refer to the 2019 Directions for Undergraduate Applicants for instructions regarding application fee payments.

SURNAME:

FIRST NAME:

FOR OFFICE USECAMPUS ID

EMPL ID:

SECTION A PERSONAL DETAILS

SECTION C PROGRAMMES OF STUDY FOR WHICH YOU ARE APPLYING

Choice Academic plan code (Table A)

1st Choice

2nd Choice

Choice Academic plan code 2 (Table A)

1st Choice S B 0 0 1

2nd Choice S B 0 0 1

Surname:

First name/s:

Preferred first name:

Other former last name:

Surname onNational Senior Certificate (for NSC writers only):

If you have applied to UCT before, enter your applicant/student number:

Are you a South African citizen? Are you a South African permanent resident?

If you need assistance because of a disability, please specify the disability/ies (Table H) so we can plan to help you:

Citizen Permanent Resident



If you are a citizen or permanent resident in a country other than South Africa, please provide details here:

Country (Table I): Citizenship status (please tick) Passport number (where available)

Sex: (please tick one) Female: Male: Trans: Home language (Table H):

Only for Faculty of

Scienceapplicants

Year written: 2 0 Y Y 2018 test date: D D M M

SECTION B NATIONAL BENCHMARK TEST (NBT) NUMBER

All applicants to undergraduate programmes normally resident, or at school, in South Africa, and all Health Sciences applicants, wherever resident, must write the NBTs. If you are required to write the NBTs, you must register for NBTs before submitting this form. Enter your 14-digit NBT registration number and, if you wrote before 2018, the year the NBTs were written. NBT results are only valid for two years prior to the year of application; so if you wrote the NBTs in 2016 or 2017, the results remain valid but you may choose to rewrite in 2018.

NBT registration number:

Title (Table H): Dateof birth: D D M M Y Y Y Y

SA identity number:

Yes No Yes No

SECTION D YOUR CONTACT DETAILS

Home (street) address:

Postal/zip code:

Email address:

Country tel code: Dialling code: Telephone number:

SECTION E PARENT / GUARDIAN CONTACT DETAILSCompulsory if you are under 18 years or if you are applying for financial assistance.

Home (street) address: Country tel code: Cell/mobile number:


Postal/zip code:

Title (Table h): Surname of parent/guardian:

First names of parent/guardian:

Email address:

Identity/passport number of parent/guardian: Relationship to you:

Relationship code (Table J):

SECTION F FEE PAYER INFORMATION If your Fee Payer is also your parent/guardian, and you completed Section E, you do not need to complete this section. If not, this section is compulsory.

Home (street) address: Country tel code: Cell/mobile number:


Postal / zip code:

Title (Table H): Surname of parent/guardian:


Email address:

Identity/passport number of parent/guardian: Relationship to you:

Relationship code (Table J):

Country tel code: Cellular number:

Home (postal) address: (if different from home (street) address)

Postal/zip code:

SECTION G REDRESS & DIVERSITY INFORMATION: SA APPLICANTS ONLY

3. What is/was your mother’s first language?

4. What is or was the highest level of education of each of your parents or guardians? University or Technikon degree ................................................................................

University or Technikon certificate or diploma .............................................................

Technical College certificate, trade certificate or similar certificate ..............................

Matric/Grade 12/Senior certificate .............................................................................

Some formal schooling .............................................................................................

No formal schooling .................................................................................................

I do not know ...........................................................................................................

5. Does or did at least one of your grandparents have:

A university qualification ..........................................................................................

A technikon degree or diploma ..................................................................................

6. Does or did your family receive a child-support grant on your behalf? ...........................

7. Does or did your family rely on a social pension from the State? ..................................

This section applies to South African undergraduate applicants only and is compulsory.

The University’s redress and diversity policies apply to South African undergraduate applicants whose parent/s was/were classified under apartheid as Black, Coloured, Chinese or Indian. Your responses to the following questions are used to calculate your redress category and disadvantage factor. The disadvantage factor will be used in the calculation of your Weighted Points Score. Refer to page 8 of the 2019 Undergraduate Prospectus for an explanation of the University’s Admissions Policy.

1. Under apartheid, my mother was classified as (please tick only one):

2. Under apartheid, my father was classified as (please tick only one):

Please tick one box in repect of each parent/guardian: (where applicable)

Yes No I do not know




Black Coloured Chinese Indian White Do not know

I choose not to answer this question My mother did not live under apartheid

Black Coloured Chinese Indian White Do not know

I choose not to answer this question My father did not live under apartheid

SECTION H 2018 SECONDARY SCHOOL-LEAVING EXAMINATION DETAILS

Schoolname:

(Table B) (Table C)

School code: Examining authority:

For Cambridge International Examinations applicants: Centre no.: Candidate no.:

Code(Table D)

Level(Table E)

School subjects to be written this year:

Complete this section if you are writing a school-leaving examination in 2018. Supply only details of secondary schools located in South Africa. If you attend school outside of South Africa, omit secondary school details.

School address:

Postal code:

(Table H)

Did you attend any other secondary school before enrolling at your present school? Yes No

Y Y Y YIf yes, in which year did you first enrol at your present school:

If yes, please provide the code of your previous school:

(Table B)

SECTION K FINANCIAL ASSISTANCE

SECTION I SECONDARY SCHOOL-LEAVING AND POST-SCHOOL INFORMATION

School address: Date written:

D D M M Y Y Y Y

Postal code:

Year Activity Code (Table F) Year Activity Code (Table F)

Y Y Y Y Y Y Y Y

Y Y Y Y Y Y Y Y

Complete this section if you have already left school. Supply only details of secondary schools located in South Africa. If you attended school outside of South Africa, omit secondary school details. Please enclose certified copies of your certificates.

Last schoolattended:

School code:

(Table C)

(Table B)

DETAILS OF ACTIVITIES SINCE LEAVING SCHOOL OTHER THAN TERTIARY EDUCATIONIf you have left school and are not at a tertiary institution, you must complete this section.

Qualification completed

Degree / diploma for which registered

Year of registration

TERTIARY EDUCATION DETAILSIf you have attempted any tertiary education or are currently registered at a tertiary institution, you must complete this section. Please enclose original transcripts or certified copies of your certificates/result statements.

SECTION J HOUSING APPLICATION

Please tick the appropriate box to apply for UCT accommodation. (See 2019 Directions for Undergraduate Applicants, page 14)

Please note we cannot guarantee accommodation for all students.

NOTE: All UCT financial assistance and NSFAS applications for funding is managed by NSFAS. Apply directly to NSFAS at www.nsfas.org.za and submit all the supporting documents to enable the easy processing of your application. The closing date for financial assistance will be available on the NSFAS website.

Please tick the appropriate box to indicate your intention to apply for student financial assistance. (See 2019 Directions for Undergraduate Applicants, page 15)

I wish to apply for student housing: Yes No

I intend to apply for UCT/NSFAS financial assistance: Yes No

School name: School code: (Table B)

Physical home address:

Postal/zip code:

Grade 10

Grade 11

Grade 12

Comment briefly (if you wish) e.g. if more than one team / organisation under e) and f) City/town, province & postal code of primary school:

a) Head girl/boy

b) Deputy head girl/boy

c) School Prefect/Student Council

d) Hostel prefect

e) Captain of sports team/s

f) Vice-Captain of sports team/s

g) Editor of a school newspaper

h) Head of debating club

i) Mentor of fellow students

j) Class representative

k) List other leadership positions inside or outside of school

Tick if your home address is in one of these: City/metro Town Urban township Rural village/farm

SECTION L PERSONAL REPORT FOR MBChB APPLICANTS

1. BIOGRAPHICAL DATAFirst name/s:

2. SCHOOL DATAa) Name of school where secondary schooling was/is being completed: City/town, province & postal code of high school:

Surname:

Applicant number or SA identity number or passport number:

Library Sports fields

Science laboratory/ies

Computer facilities

Clubs and societies

b) Did your last high school offer these facilities? (tick block)

3. LEADERSHIP POSITION/S (ONLY WHILE AT HIGH SCHOOL) Please tick where appropriate Please note: One can show leadership qualities in many ways, formally and informally. If your school did not offer the positions below please feel free to elaborate in section k). If your school principal is unable to verify your entry, please supply a letter from a person of authority in your community who would be able to verify your entry.

• Do not write in the grey areas.• All school-leaving MBChB applicants (and those on a gap year in 2018) are invited to submit Personal Reports (PR). Applicants who have done

tertiary study are invited to submit a CV (Section M).• If you choose not to submit a PR, you will compete with applicants who do submit a PR. The maximum score that will be awarded for the PR is 100

points but if you do not submit the PR, you will be awarded zero points.• If you do not supply evidence required for activities outside of your school you will not get points for those activities. Only original signed letters

are acceptable.• Complete the form, ask your principal to complete and sign section 8, then post original by 1 OCTOBER 2018 to:

The Undergraduate Admissions Office, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925.

If you are at school, applying for admission to the MBChB programme,and you wish to submit the Personal Report, detach this page, which must be submitted separately

Province

Dialling code: Telephone number:

Dialling code: Cell/mobile number:

SECTION L Continued

4. COMMUNITY SERVICE/VOLUNTARY WORK DURING HIGH SCHOOL YEARS (in and outside of school) Notes: (1) Attach ORIGINAL SIGNED letters confirming involvement for activities outside of your school. You will not be given marks for activities outside of your school if you do not submit evidence of such involvement. (2) Please do not use ACRONYMS, write out the names of organisations and describe what you did while you were a member.

6. SPORTING ACTIVITIES INSIDE OR OUTSIDE SCHOOL, DURING YOUR HIGH SCHOOL YEARS (Attach proof of club/provincial/national level activities outside of school)

7. WHAT OTHER ACTIVITIES OR ACHIEVEMENTS DURING YOUR HIGH SCHOOL YEARS OR AFTER GRADE 12 DO YOU WISH TO HIGHLIGHT THAT YOU FEEL TAUGHT YOU LIFE SKILLS OR ARE RELEVANT TO YOUR APPLICATION? For how long did you take part in this activity? Attach ORIGINAL, SIGNED proof from organisation or a letter from a person of authority who is not family if this is not a school activity, such as a church leader. Please note: One can learn life skills in many situations. For example, taking care of an ailing parent or grandparent or of siblings, working as a waiter or waitress. Please feel free to enter any activity that you think taught you life skills, inside or outside of school.

8. VERIFICATION BY SCHOOL PRINCIPAL OR HIS/HER DELEGATE OF ACCURACY OF SCHOOL ACTIVITIES LISTED IN SECTIONS 2 TO 7

Organisation Grade 10 Grade 11 Grade 12

Weekly (W) orMonthly (M) orIrregularly (I) orOnce-off (O)?

Did your school organise this (S)or is this an activity outside of your school which you started on your own?

Have you attached proof of your involvement in activities outside school?(YES or NO)

a) Give details of any OTHER contribution you may have made to your school or community during your high school years, and indicate when you took part in this activity.

5. CULTURAL ACTIVITIES, CLUBS, SOCIETIES ETC DURING HIGH SCHOOL YEARS (in or outside school) E.g. Church school or other choir; musical instrument, debating society. Attach original signed letter of proof for each activity outside your school.

Activity Grade 10 Grade 11 Grade 12

Weekly (W) orMonthly (M) orIrregularly (I) orOnce-off (O)?

Is this activity offered by your school (S) or an organisation outside of your school (OS)?

Have you attached proof of your involvement in activities outside school?(YES or NO)

List up to 3 sports in which you participated regularly while at high school Have you attached

proof of your involvement in activities outside school?(YES or NO)

In which grade/s (tick): 10: 11: 12: 10: 11: 12: 10: 11: 12:

At which level did you participate?

(i) Social (outside school)

(ii) Club (outside school)

(iii) School

(iv) Provincial or National

Describe any exceptional achievement

Name Please sign to show that you are able to verify all school activities

Position (e.g. principal) SCHOOL STAMP

Telephone number

Signature

Physical home address: Province:


Dialling code: Cell/mobile number:

Postal/zip Code:

Tick if your home address is in one of these: City/metro Town Urban township Rural village/farm

If you are applying for admission to the MBChB programme and have attempted tertiary studies,you may wish to submit a CV. Detach this section and submit it separately.

SECTION M CURRICULUM VITAE FOR ALL MBChB APPLICANTS WHO HAVE ATTEMPTED TERTIARY STUDIES

• All MBChB applicants who have studied at tertiary level are invited to submit a CV.• The CV is used to distinguish between applicants with similar academic records.• Please supply supporting documentation and/or contact details of persons in positions of authority who are in a position to verify information in your CV.

In a CV of not more than 300 words, give an account of your extra-curricular activities at and since leaving school. We would be interested in leadership positions, all forms of community engagement, team or individual sporting activities, cultural activities, special achievement and other interests/hobbies. Please supply supporting documentation where possible, and the contact details of persons in positions of authority (who are not related to you) who are able to verify information in your CV. Submit:(a) this form(b) your CV(c) all supporting documentation

To: The Undergraduate Admissions Office Faculty of Health Sciences University of Cape Town Anzio Road Observatory 7925By no later than 1 October 2018.


Surname:

Applicant number or SA identity number or passport number:

2. SCHOOL DATAa) Name of last primary school attended: City/town, province & postal code of primary school:

b) Name of last high school attended: City/town, province & postal code of high school:

Library Sports fields

Science laboratory/ies

Computer facilities

Clubs and societies

c) Did your last high school offer these facilities? (tick block)

SECTION M CURRICULUM VITAE

Bachelor of Arts (Fine Art) applicants: You must detach and return the completed form with your portfolio

Home (street) address: Dialling code: Cell/mobile number:


Postal/zip code:

FOR OFFICE USEApplicant Number:


Surname:

SECTION N FOR BACHELOR OF ARTS IN FINE ART APPLICANTS

E-mail address:

Date of birth: D D M M Y Y Y Y

HIGH SCHOOLEnter the secondary school where you completed/are completing your secondary schooling. Please attach your latest school report to this form.

Year finished school: Y Y Y Y YES NO

POST SCHOOLIf you are not at school this year please complete the following section:

Will you qualify for eligibility to do degree studies (or have you previously qualified to do so)?)

Give detailed information of what you have done since leaving school on a separate sheet.

• Refer to page 7 of 2019 Directions for Undergraduate Applicants for portfolio requirements.• Please supply all the details requested, as the information will assist your application.• This form must be submitted with your portfolio. The preferred date for Portfolio submissions is 31 August 2018. The final date for submission is 1 October 2018.• We reserve the right not to evaluate an incorrect or incomplete portfolio.• Return to: The Secretary The Michaelis School of Fine Art Hiddingh Campus 31-37 Orange Street Gardens 8001, Cape Town

If you need assistance because of a disability, please indicate YES NO

Qualification completed

Degree/diploma for which registered

Year of registrationSchool name: School code: (Table B)

Disability Unit contact details. Email: [email protected] Telephone: (021) 650 2427

DECLARATION OF AUTHENTICITY OF WORK

The portfolio submitted with this form is my own work:

Signature of Applicant:

SECTION N FOR BACHELOR OF ARTS IN FINE ART APPLICANTS (continued)

D D M M Y Y Y Y

STATEMENT Write a motivation (250-500 words) detailing why you want to study Fine Art, and indicate your future goals.

• Refer to page 6 of 2019 Directions for Undergraduate Applicants for portfolio requirements.• Please supply all the details requested, as the information will assist your application. • This form must be submitted with your portfolio. The preferred date for Portfolio submissions is 31 July 2018. The final closing date for portfolio submissions is 1 October 2018. We reserve the right not to evaluate an incorrect or incomplete portfolio. • Return to: The Administrator The School of Architecture University of Cape Town Private Bag X3 7701, Rondebosch

Bachelor of Architectural Studies applicants You must complete, detach and return this form with your portfolio.

FOR OFFICE USEApplicant Number:

First name/s:

Surname:

SECTION O FOR BACHELOR OF ARCHITECTURAL STUDIES (BAS) APPLICANTS

Is this the first time you have applied for the BAS degree at UCT? YES NO

Have you done a course in Architecture or Built Environment Studies at another institution? YES NO

Have you had formal art lessons (either at school or privately)? YES NO

Describe these:

Have you had Design and Technology lessons at school? YES NO

Describe these:

If YES, describe the course and state the level which you have achieved:

State (year by year) what you have done since leaving school (if necessary use a separate page):

POST SCHOOLIf you are NOT at school this year please complete the following section:

EDUCATIONAL OBJECTIVESAre you interested in pursuing a career in: (please tick areas of interest)

State (year by year) what you have done since leaving school (if necessary use a separate page):

1. Landscape architecture 2. City and regional planning 3. Urban design 4. Architecture

SECTION P DECLARATIONS BY APPLICANT AND PARENT/GUARDIAN

Without prejudice to the terms of my application for admission, I make the following declarations:

1. I will abide by the University’s rules.

2. I hold myself responsible for: the payment of all fees and charges due and payable by me to UCT each year; any arrears and interest on arrears

as defined in this year’s fee booklet; and any costs of recovery, including attorney-and-client scale fees and/or collection commission. If I do

not inform the Registrar in writing of withdrawal from studies or a course by the prescribed date(s) I will be liable for full fees even if I do not

make use of UCT facilities.

3. I accept, agree and understand that: UCT may keep and process data and documents in electronic format, including the personal data

supplied by me in my application form and in this registration form, and my image and fingerprints (both to be used solely for identification

purposes); UCT may use and transfer such data and use such documents in electronic or other formats for UCT purposes consistent with

UCT’s relationship with me as a student and former student including submission of data for the National Learners’ Record Database and

other returns as required by the Department of Higher Education and Training; that UCT places records of qualifications awarded in the

public domain; that UCT may process my personal information in accordance with its rules and policies for academic and administrative

purposes, including disciplinary processes and that UCT may use electronically generated documents in place of the originals signed by me.

4. I waive all claims against UCT for: any damage or loss suffered while I am, or as a consequence of my being, a UCT student and/or arising out

of loss or destruction of, or damage to, any property belonging to me or any other person.

5. I have not been expelled, rusticated, or excluded from any other University.

6. If I am a minor, I have the consent of my parent(s)/guardian to sign this form.

7. The information given on this form is complete and accurate. If I fail to disclose or falsely declare information (for example, non-disclosure of

previous tertiary studies), this could lead to disciplinary action and/or the cancellation of my application and/or registration at UCT.

Signature of applicant:..................................................................................... Date: D D M M Y Y Y Y

DECLARATION AND SURETYSHIP BY PARENT OR LEGAL GUARDIAN

If you are under 18, your parent/legal guardian must make this declaration. If you are 18 or older and your parent/legal guardian will be paying your fees, your parent/legal guardian must make this declaration.

Details of parent/guardian. (PLEASE PRINT)

Signature of parent/legal guardian: ........................................................................... Date: D D M M Y Y Y Y

I agree and consent to the above declaration, undertakings, waiver and indemnity by the applicant. I consent to the applicant signing registration forms if admitted. I hold myself jointly and severally liable with the applicant as co-debtor for all amounts due by the applicant to the University, until I notify the University to the contrary, in which event such cancellation shall take effect only from the beginning of the following academic year. I consent to the University holding and processing personal information supplied by me in this application (including any application for financial aid) for purposes related to this application.

* NOTE: An applicant under the age of 18 must have this form signed by either of his/her parents. Where an applicant has no parents (e.g. they are deceased) or the parents are divorced, a legal guardian is normally officially appointed. In such cases the legal guardian must sign this form. If you do not have a parent or legal guardian, a responsible adult family member (next-of-kin) or other responsible adult who is prepared to make the declaration and the undertaking, must sign with you.The details of this person must be listed under the parent/guardian section on this form.

Postal address: Country tel code: Cell/mobile number:

Identity/passport number of parent/guardian:

Postal/zip code:

Title (Table H): Surname of parent/guardian:


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empl id: 2019 application for … · 2019 application for undergraduate admission ... certificate...

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