Application Form 2010

DSAR 01 For office use only:

APPLICATION TO STUDY AT UNISA INSTRUCTIONS: • • • • • • •

Please complete this form in black ink. This application form is for NEW students intending to apply for undergraduate or postgraduate formal studies. Unisa will send you a reference number by e-mail, SMS or mail after the form has been processed. Refer to the Your choice @ Unisa booklet and pages 3 and 4 of this application form for the applicable codes. Please note that the application fee (R150,00) is non-refundable. NB: Unisa does not accept cash or cheques. Your application will only be finalised on receipt of supporting documents (see the Your choice @ Unisa booklet) and the nonrefundable application fee. Note: The university reserves the right to request original educational qualifications. CLOSING DATES MUST BE ADHERED TO.

1. a) Proposed qualification (eg BCom)

1. b) Specialisation

2. Qualification code (eg 02011) 3. Surname 4. Initials

5. Title

6. Full name 7. Maiden name and/or previous surname (if applicable) 8. Date of birth

D

D

M

M

Y

Y

Y

Y

9. Gender (mark with an X)

10. Language of correspondence (mark with an X)

Male

Afrikaans

Female

English

11. Identity (RSA) or passport number (foreigners) 12. a) Do you have a disability? Yes

No

12. b) Nature of your disability (see codes)

13. Telephone numbers

Home

Contact number for courier

(dialling code & number)

Work

Cell (format +27 83 111111)

(eg 011 839 4671 x2769)

E-mail

Fax

14. Postal address and postal code

Physical address and postal code

Address for personal delivery from Unisa (eg courier of study material during office hours)

Postal code

Postal code

Postal code

15. Examination centre code (please refer to the Your choice @ UNISA booklet) 16. Home language 18. Population group for statistical purposes (mark with an X) 19. Occupation (code) 21. Do you intend applying for financial aid? (mark with an X)

17. Nationality African

Coloured

Indian

White

Other

20. Economic sector (code) No

NSFAS (RSA only)

Eduloan

Applications Office: PO Box 1 Unisarand 0148 Tel: 086 1670 411 or +27 11 670 9000 Fax: 012 429 8116

22. After you have worked through Your choice @ Unisa, do you require further assistance with career planning and the appropriate selection of a study programme and subjects? (mark with an X)

Yes

No

23. May your name and contact details be given to fellow students for academic purposes? (mark with an X)

Yes

No

24. School leaving particulars: Type of certificate (mark with an X) Senior Certificate

National Senior Certificate (NSC) from 2008

Other (please specify, such as O-levels)

Current Grade 12

_______________________________________________________________________

Result achieved (mark with an X)  Std 10/Grade 12 with full exemption

Std10/Grade 12 without exemption

NSC entry-level bachelor's degree

NSC entry-level diploma

NSC entry-level Higher Certificate

Did not pass Std 10/Grade 12

Other (please specify eg O-levels) 25. Examination number (RSA applicants)

26. Year completed (RSA applicants)

27. Province (RSA applicants)

Give particulars of last tertiary institution at which you were registered before 2009: 28. Institution (eg University of Cape Town) 29. Last year of registration 30. a) Indicate undergraduate or postgraduate

b) Name of qualification

31. Do you intend applying for course exemptions/credits from previous studies? (mark with an X)

Yes

No

32. If yes, indicate student number from other institution 33. Do you need training in basic computer skills? (mark with an X) 34. Do you have access to the following? (mark with an X)

Internet

Yes

Cellphone

CD Rom (on a computer)

No DVD Rom (on a computer)

MP3 Player

I declare that all the particulars furnished by me on this form are true and correct. I undertake to comply with all the rules, regulations and decisions of the university and any amendments thereto, and I have taken note of advice which may be applicable to students in general.

Surname: ______________________________________

First names:

Applicant's signature: _______________________________________

________________________________________

Date: ______________________________________

PAYMENT CAN BE MADE IN ONE OF THE FOLLOWING WAYS: NATIONAL APPLICANTS: Postal order, credit card. When applying online, application payment can be made at www.unisa.ac.za INTERNATIONAL APPLICANTS: Credit card or SWIFT. Attach proof of payment when using SWIFT.

CREDIT CARD PAYMENT C/card no

M

Expiry date

M

Y

Y

Y

Y

If payment is on budget, mark period in months with √

6

12

18

24

36

a) Card holder: identity number b) Card holder: surname & initials c) CV number (last three digits on the back of the card)

d) Signature

………………………………………………………………………………………………………………………………………………… CHECKLIST FOR APPLICATION Items that must be submitted before your application will be processed: Application form (which you must submit using the pre-addressed envelope) A certified copy of school qualifications (eg Senior Certificate) A certified copy of all tertiary qualification(s), academic record and conduct certificate (where applicable) A certified copy of ID document (RSA students) or passport/birth certificate (foreign students) A certified copy of marriage certificate (where applicable) or divorce order (where applicable) Application fee (R150,00) Original official translations of document(s) if they are not in English or Afrikaans

APPLICATION DATES AND FEES: Category

Opens

Closes

Fees

1 July 2009

16 October 2009

R150,00

15 March 2010

30 April 2010

R150,00

1 July 2009

30 June 2010

R150,00

Semester 1, year modules, Hons, BTech and structured Masters Semester 2 Research Master’s and doctoral degrees

CODES:

A)

DISABILITY CODES (for question 12)

CODE

DISABILITY

CODE

DISABILITY

02

Visually impaired: blind

13

Muscular/skeletal/joint/limb deficiencies/diseases, such as polio or muscular dystrophy

03

Visually impaired: not blind. Find it difficult to read printed text. CANNOT study through reading. Need help in the form of audio cassettes, enlarged print or computer discs for computers with voice synthesizers

14

Other neurological diseases, such as multiple sclerosis

04

Visually impaired: not blind. CAN study through reading. Do not need study material on audio cassette

15

Cardiovascular diseases, such as heart disease or blood pressure

05

Hearing disability: study material on audio cassette should be transcribed

16

Kidney and blood deficiencies

06

Deaf

17

Stroke/brain disorders

07

Dyslexia and other similar learning disabilities

18

Mental health problems/mental disorders/phobias/chemical imbalances

08

Communication and speech problems, such as stuttering

19

Diabetes

09

Cerebral palsied

20

Serious chronic diseases

10

Paraplegic

21

Multiple disabilities

11

Quadriplegic

22

Disabilities not mentioned

12

Epilepsy

23

In a wheelchair

B)

OCCUPATION (for question 19):

CODE

OCCUPATION

CODE

OCCUPATION

01015

Accountant/auditor

01279

Technical worker (other)

01023

Architect/quantity surveyor

02003

Manager/administrator

01031

Computer specialist

0300X

Sales worker

0104X

Engineer

04006

Clerical or related worker

01058

Farm management advisor

05002

Craftsman/including craftswoman or related worker

01066

Forester/conservationist

06009

Operator (except transport)

01074

Home management advisor

07005

Operative (transport)

01082

Jurist

08001

Labourer (except farm)

01090

Librarian/archivist

09008

Farmer/farm manager

01104

Mathematician

10006

Farm labourer/farm foreman

01112

Life/physical scientist

11010

Prison service worker

01120

Ops research/systems analyst

11029

Firefighter

01139

Personnel officer

11037

Police officer/detective

01147

Medical doctor/dentist, etc

11045

Citizen force member

01155

Nurse, dietician, etc

11053

Permanent force member

01163

Health technologist/technician

11061

National service trainee

01171

Religious worker

1107X

Protection service (other)

0118X

Social scientist

11088

Service worker (other)

01198

Social/recreation worker

12009

Housewife

01201

Lecturer/professor

13013

Full-time student at Unisa

0121X

Teacher (primary/secondary)

13021

Full-time student (elsewhere)

01228

Engineering/science technician

14001

Occupation not classified

01236

Technician (other)

15008

Unemployed

01244

Vocational counsellor

16004

Retired

01252

Writer/artist/musician

17000

Occupation unknown

01260

Research worker not classified

C)

ECONOMIC SECTOR (for question 20)

CODE

ECONOMIC SECTOR

CODE

ECONOMIC SECTOR

01007

Agriculture, forestry and fisheries

02003

Mining

08001

Business and repair services

01236

Other technicians

0300X

Construction

09008

Personal services, including hotel and household services

11215

Education: primary or pre-primary

11401

Professional and related services NOT listed elsewhere

11223

Education: secondary

11509

Public administration: public service, provincial administration, city councils, municipalities, and so on

11231

Education: tertiary

05002

Transportation, communication and other public utilities

10006

Entertainment and recreational services

11304

Welfare and non-profit membership organisations

07005

Finance, insurance and real estate

06009

Wholesale and retail trade

1110X

Hospital and health services

11606

Not applicable (any sector not mentioned above, such as housewives, pensioners or unemployed)

04006

Manufacturing