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 Date of Birth : Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth : Day Day12345678910111213141516171819202122232425262728293031 Date of Birth : Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Nationality Home address Postal Code Cellphone number Telephone Number Disability E-mail Postal address (if different from home address) Postal Code 2 Work address 2 Telephone (W) Fax number B. School and Post-school activities University/College/Technikon/School Period from to Name of Degree/Diploma/Certificate Study completed - None -YesNo University/College/Technikon/School Period from to Name of Degree/Diploma/Certificate Study completed - None -YesNo University/College/Technikon/School Period from to Name of Degree/Diploma/Certificate Study completed - None -YesNo C. Employment Record Name of Company Industry Job title or Position Date from Date from: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 to to: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Name of Company Industry Job title or Position Date from Date from: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 to to: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Name of Company Industry Job title or Position Date from Date from: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 to to: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Controlling Company Subsidiary/Section Nature of Business Title Position Number of Employees Number of Years in Position Responsibilities 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) Details for invoicing purposes Registered Company Name Company Address Details Company Vat Reg. No. Postal Code Contact Credentials of Creditors Department Telephone number of Creditors Department Documentation required Photo Upload Image size must be 300px x 400px Files must be less than 2 MB. Allowed file types: gif jpg jpeg png. Upload requirementsOne file only.2 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. ID / Passport document Upload Files must be less than 2 MB. Allowed file types: gif jpg jpeg png pdf. Upload requirementsOne file only.2 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Certificate of highest qualification Upload Files must be less than 2 MB. Allowed file types: gif jpg jpeg png pdf. Upload requirementsOne file only.2 MB limit.Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. A letter from participants employer Upload Upload requirementsOne file only.2 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. × Status message × This application, once approved, becomes a legal and binding agreement between the applicant and the Unit for Continuous Education which is irrevocable. I agree to the terms of service. UCE Terms and Conditions This application, once approved, becomes a legal and binding agreement between the applicant and the Unit for Continuous Education which is irrevocable. UCE terms and Conditions Submit Leave this field blank
