C-Mature Age Entry-2(A3-only)(2012).indd - University of Namibia

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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 apply for a study permit from your country of origin.(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 NoDo you suffer from any nervous affecon or mental abnormality? YesIf ‘yes’ please give details of the nature, severity, date and duraon of the illness.No(for planning purposes only)Do you suffer from any other illness? Yes NoIf ‘yes’ please give details of the nature, severity, date and duraon of the illness.(for planning purposes only)(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 ## Symbol(See table below)LEVELON = NSSC IG = IGCSE AL = A LEVEL HG = HIGHER GRADENH = NSSC HI = HIGCSE OL = O-LEVEL SG = STANDARD GRADELG = 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 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.
Page 4: SECTION 10: RELEVANT WORK EXPERIENC

C-Mature Age Entry-2(A3-only)(2012).indd - University of Namibia

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