This form is currently under construction. Short Learning Programme, Short Course or Workshop A. Personal Details Initials and surname Title - None -MrMsMrsDrProf Full names Nickname ID no./ Passport Date of birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003 Nationality Home address Postal Code Cellphone number Telephone number (H) Disability E-mail Postal address (if different from home address) Postal code Work address Telephone number (W) Fax number B. School and Post-school activities Complete in reverse order (starting with the most recent) all academic work, including qualifications (compulsory for evaluation purpose). University/College/Technikon/School Period from Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 to Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Name of Degree/Diploma/Certificate Study completed - None -YesNo University/College/Technikon/School Period from Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 to Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Name of Degree/Diploma/Certificate Study completed - None -YesNo University/College/Technikon/School Period from Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 to Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Name of Degree/Diploma/Certificate Study completed - None -YesNo D. Payment Options Payment enclosed - None -ChequePostal orderElectronic Fund Transfer (EFT)RealPay Account details ABSA Bank Account No. 670 642 313 Branch Code 632005 Ref: Invoice Number Cheques should be made out to North-West University (No cash please) Please e-mail proof of payment to UCE-Info@nwu.ac.za Entity responsible for payment - None -SelfCompany If self and are unable to pay full study fees immediately, please complete the RealPay debit order option form. (Available on request) E. Documentation required Photo Image size must be 300px x 400pxFiles must be less than 2 MB.Allowed file types: gif jpg jpeg png. ID / Passport document Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf. Certificate of highest qualification Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf. This application, once approved, becomes a legal and binding agreement between the applicant and the Unit for Continuous Education which is irrevocable. Terms & Conditions * I agree that I've read the Terms and Conditions Leave this field blank CAPTCHA This question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image? * Submit