B-Distance Education-CES-1(2011).indd - University of Namibia

B: DISTANCE EDUCATION (CES)UNIVERSITY OF NAMIBIACHECKLIST FOR APPLICANTS: (Please mark enclosed)ID Document - cerfied copy orPassport - cerfied copy orACADEMIC YEAR APPLIED FOR:PASSPORT PHOTOOF APPLICANT(Compulsory)Birth Cerficate - cerfied copyThis applicaon is not binding oneither the applicant or the Universityof Namibia. All informaon willbe treated as confidenal. Anapplicaon fee as specified belowmust accompany this applicaon.School Leaving Cerficate - cerfied copyApplicaon FeeMarriage Cerficate - cerfied copy (if applicable)Degree/Diploma - cerfied copy (if applicable)Academic Record (if applicable)The closing date for applicaons:30 SEPTEMBERThe closing date for late applicaons:31 OCTOBERPlease aacha recentpassportphotographof yourself.Instrucons: Use block leers to complete this form where space is provided or place an ‘X’ in the correct square. Incomplete applicaons will not beaccepted. All cerfied documents will be filed - no copies will be returned to applicants. Cerficaon of all documents should be doneby the UNAM Regional Centres. The University of Namibia will not be held responsible for the loss of any original documents.Applicaon Fees (Non-refundable)The following must be paid in crossed postal orders, made out tothe University of Namibia.• Namibian Applicants (unl 30 Sept) N$100• Internaonal Applicants (unl 30 Sept) N$200• Late Namibian Applicants (unl 31 Oct) N$200• Late Internaonal Applicants (unl 31 Oct) N$300SECTION 1: PROPOSED COURSE OF STUDYSECTION 2: APPLICANT’S PARTICULARSSECTION 3 : CONTACT PARTICULARSCompleted applicaon forms must be mailed to:The Office of the Registrar, University of Namibia,Private Bag 13301, Windhoek, NAMIBIA.STUDENT NUMBER:For Official UseCourse of study for which you wish to enrol:Indicate nearest UNAM Centre:First Choice: Undergraduate PostgraduateSecond Choice: Undergraduate Postgraduate(Your second choice will be considered if your first choice applicaon is unsuccessful.)Title: Mr Ms Other(specify)Surname:First Name in full:Postal Address:Residenal Address:Inials:(NOTE: Postal addresses or telephone numbers of schools or hostels are unacceptable for applicaon purposes, since correspondence may be mailed to youwell aer you have le your school or hostel.) + Code:Cell No:Fax No:E-mail:FOR OFFICIAL USE ONLY:ACCEPT FIRST CHOICE ACCEPT SECOND CHOICE RETURNED REJECTEDCONDITIONS APPLICABLE:SYMBOLS OBTAINED:OVERALL POINTS OBTAINED: ENGLISH MATHEMATICS BIOLOGY PHYSICAL SCIENCE

SECTION 4: PERSONAL PARTICULARSDate of Birth: D D M M Y Y Y YI.D. No.:Passport No.: Marital Status: Single MarriedGender: M F Maiden Name:Mother Tongue:Home Town:Cizenship: Namibian Other (specify)If not a Namibian cizen, please state Pemanent Residence Work Permittype of permit in your possession Study Permit No PermitState your permit number:Expiry date of permit:D D M M Y Y Y Y(if applicable)Do you have a disability? Yes No(for planning purposes only)If ‘yes’ please specify.Based on your disability, do you have special needs? Yes No(Please note that you may be contacted.)SECTION 5: EMPLOYMENT PARTICULARS (only if applicant is in full-me employment)Name of Employer:Your Occupaon:Employer’s Postal Address:Employer’s Telephone No.:SECTION 6: APPLICANT’S NEXT OF KIN/LEGAL GUARDIAN PARTICULARS(To be contacted in case of emergency.)Family relaonship with the person whose parculars are supplied.Father Mother Spouse/partner GuardianTitle: Mr Ms Other (specify)Surname:First Names in full:InialsI.D. No.:Home Address (next of kin/guardian):Tel No.: WorkTel. No.: HomeCell No.:Employer (next of kin/guardian):Occupaon:Employer’s Address:SECTION 7: FORMAL STATISTICAL INFORMATIONRegion of Origin (if residing in Namibia) or country of permanent residence:KarasOmusaHardapOshanaKhomasOhangwenaErongoOtjikotoOmahekeKavangoOtjozondjupaCapriviKuneneOther (specify)

SECTION 8: SCHOOL LEAVING PARTICULARSLast secondary school aended:Address of school:Highest grade passed:Current grade (if applicable):Date of examinaon:Examinaon number:Examinaon body:Note: A cerfied copy of your School Leaving Cerficate should accompany this applicaon. Please furnish your NAMIBIAN SchoolLeaving Cerficate (Grade 12) if you aended a Secondary School in Namibia.Subject Level ## SymbolLEVELI = IGCSE H = HIGHER GRADE A = A LEVEL + = NSSC (O)* = HIGCSE S = STANDARD GRADE I = O-LEVEL # = NSSC (H)L = LOWER GRADEInternaonal students should note that only original School Leaving Cerficates or an Advice of Results with a confirmaon from the relevant ExaminaonAuthority stang that cerficates will be issued during the first year of registraon, will be accepted. No mock results or School Rapports will be considered.SECTION 9: POST-SCHOOL ACADEMIC QUALIFICATIONSNote: A full Academic Record issued by the instuon should accompany this applicaon.Student No. From Year To Year Name of University/Technikon/CollegeName of Programme (e.g. BA): Awarded: Y NStudent No. From Year To Year Name of University/Technikon/CollegeName of Programme (e.g. BA): Awarded: Y NStudent No. From Year To Year Name of University/Technikon/CollegeName of Programme (e.g. BA): Awarded: Y NStudent No. From Year To Year Name of University/Technikon/CollegeName of Programme (e.g. BA): Awarded: Y NHave you ever been refused admission to any Terary Instuon? Y NAre you currently enrolled at the University of Namibia? Y NIf ‘yes’ please indicate course of study.

SECTION 10: RELEVANT WORK EXPERIENCE (Indicate nature of work)Acvity Level Posion HeldSECTION 11: ACHIEVEMENTSA. SPORT & CULTURESpecify achievements and also the level(s) at which you have parcipated (school, club, regional, naonal):AcvityLevelB. GENERALIndicate any leadership posions held:PosionField of AcvityDECLARATIONI hereby declare that all the parculars given in this applicaon form are true and correct. I further declare that my enrolment as a studentat the University of Namibia (UNAM) shall be subject to the terms and condions contained in the agreement, which I shall complete andsign at registraon.SIGNATURE OF APPLICANTDateSIGNATURE OF GUARDIAN(If applicant is under 21 years of age)DateBANK DETAILSUNIVERSITY OF NAMIBIAFIRST NATIONAL BANK - WINDHOEKAccount number: 55500057621Branch code: 281872Swi code: FIRNNANXFax number: +264 61 206 3704/3121FOR OFFICIAL USE ONLY:APPLICATION FEE RECEIVED: _____________ RECEIPT NUMBER: _________________________LATE FEE RECEIVED: ____________________ RECEIPT NUMBER: _________________________