APPLICATION FOR UNDERGRADUATE ADMISSION 2018 • Apply online. Use this booklet only if you do not have access to the internet. • If you are currently registered at UCT you must apply online. • Complete this form in conjunction with the 2018 Directions for Undergraduate Applicants. which includes information and all the code tables you need. Information in shaded areas may be found in the Directions for Undergraduate Applicants. • Please complete this form in CAPITAL LETTERS in ink (or a ballpoint pen). • Return this completed form by post or in person. This form must not be faxed or emailed. • DO NOT submit your application fee with this form. Refer to the 2018 Directions for Undergraduate Applicants for instructions regarding applications fee payments. FIRST NAME: SURNAME: APPLICANT NUMBER: FOR OFFICE USE:
Transcript
APPLICATION FOR UNDERGRADUATE ADmIssION
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• Applyonline.Usethisbookletonlyifyoudonothaveaccesstotheinternet.• IfyouarecurrentlyregisteredatUCTyoumustapplyonline.• Completethisforminconjunctionwiththe2018 Directions for Undergraduate Applicants. whichincludesinformationandallthecodetablesyouneed.Informationinshadedareasmaybe foundintheDirectionsforUndergraduateApplicants.• PleasecompletethisforminCAPITALLETTERSinink(oraballpointpen).• Returnthiscompletedformbypostorinperson.Thisformmustnotbefaxedoremailed.• DONOTsubmityourapplicationfeewiththisform.Refertothe2018 Directions for Undergraduate Applicants forinstructionsregardingapplicationsfeepayments.
FIRST NAME: SURNAME:
ApplIcANT NUMbER: FoR oFFIcE USE:
If NbTs were written previously, state year: 2 0 Y Y 2017
test date: D D M M
plEASE TIcK: YES No If YES, enter your Applicant / Student Number:
SECTION A2 NATIONAL BENCHMARK TEST (NBT) NUMBER
SECTION B PERSONAL DETAILS
SECTION A1 PREVIOUS APPLICANT NUMBER
SECTION C PROGRAMMES OF STUDY FOR WHICH YOU ARE APPLYING
choice Academic plan code (Table A)
1st choice
2nd choice
choice Academic plan code 2* (Table A)
1st choice
2nd choice
Title (Table H): Dateof birth: D D M M Y Y Y Y
Surname /last Name:
First Names:
preferred First Name:
other former last Name:
last Name onNational Senior certificate (for NSc writers only):
All applicants to Undergraduate programmes normally resident, or at school, in South Africa, and all Health Sciences applicants, wherever resident, must write the NbTs. If you are required to write the NbTs, you must register for NbTs before submitting this form. Enter your 14-digit NbT registration number and, if you wrote before 2017, the year the NbTs were written. NbT results are only valid for two years prior to the year of application; so if you wrote the NbTs in 2015 or 2016, the results remain valid but you may choose to rewrite in 2017.
HAVE YoU EVER ApplIED To oR bEEN REGISTERED AT UcT bEFoRE?
SA Identity Number:
If you are a South African citizen or permanent resident in South Africa, please provide the following:
YES No
If YES, please specify the disability/ies (Table H) so we can plan to help Will you need assistance because of a disability? (please tick)
1 3 5
2 4 6
If you are a citizen or permanent resident in a country other than South Africa, please provide details here:
country (Table I): citizenship status (Table H): passport number (where available)
Sex (Table H): Home language (Table H):
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*Submit a second Academic plan
code oNlY if you are applying for admission to a programme in the
Science Faculty:
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SECTION D YOUR CONTACT DETAILS
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Home (Street) Address:
postal / Zip code:
E-mail Address:
country Tel code: Dialling code: Telephone Number:
SECTION E PARENT / GUARDIAN CONTACT DETAILScompulsory if you are under 18 years or if you are applying for financial assistance.
Home (Street) Address: country Tel code: cell / Mobile Number:
country Tel code: Dialling code: Telephone Number:
postal / Zip code:
Title (Table H): Surname / last Name of parent / Guardian:
First Names of parent / Guardian:
E-mail Address:
Identity / passport Number of parent / Guardian: Relationship to you:
Relationship code (Table J):
SECTION F FEE PAYER INFORMATION If your Fee payer is also your parent / guardian, and you completed Section E, you do not need to complete this section. If not, this section is compulsory.
Home (Street) Address: country Tel code: cell / Mobile Number:
country Tel code: Dialling code: Telephone Number:
postal / Zip code:
Title (Table H): Surname / last Name of parent /Guardian:
First Names of parent / Guardian:
E-mail Address:
Identity / passport Number of parent / Guardian: Relationship to you:
Relationship code (Table J):
country Tel code: Dialling code:
Home (postal) Address: (if different from Home (Street) Address)
postal / Zip code:
SECTION G REDRESS & DIVERSITY INFORMATION: SA APPLICANTS ONLY
3. What is / was your mother’s first language?
4. What is or was the highest level of education of each of your parents or guardians? please tick one box in repect of each parent / guardian: (where applicable)
University or Technikon degree ................................................................................
University or Technikon certificate or diploma .............................................................
Technical college certificate, trade certificate or similar certificate ..............................
Some formal schooling .............................................................................................
No formal schooling .................................................................................................
I do not know ...........................................................................................................
5. Does or did at least one of your grandparents have:
A university qualification ..........................................................................................
A technikon degree or diploma ..................................................................................
6. Does or did your family receive a child-support grant on your behalf? ...........................
7. Does or did your family rely on a social pension from the State? ..................................
This section applies to South African undergraduate applicants only and is compulsory.
The University’s redress and diversity policies apply to South African undergraduate applicants whose parent/s was/were classified under apartheid as black, coloured, chinese or Indian. Your responses to the following questions are used to calculate your redress category and disadvantage factor. The disadvantage factor will be used in the calculation of your Weighted points Score. Refer to page 15 of the 2017 Undergraduate prospectus for an explanation of the University’s Admissions policy.
1. Under apartheid, my mother was classified as (please tick only one):
2. Under apartheid, my father was classified as (please tick only one):
Mother or female guardian
Father or male guardian
Yes No I do not know
Yes No I do not know
Yes No I do not know
Yes No I do not know
black coloured chinese Indian White Do not know
I choose not to answer this question My mother did not live under apartheid
black coloured chinese Indian White Do not know
I choose not to answer this question My father did not live under apartheid
SECTION H 2017 SECONDARY SCHOOL-LEAVING EXAMINATION DETAILS
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SchoolName:
(Table b) (Table c)
School code: Examining Authority:
For cambridge International Examinations applicants: centre no.: candidate no.:
code(Table D)
level(Table E)
School subjects to be written this year:
complete this section if you are writing a school-leaving examination in 2017. Supply only details of secondary schools located in South Africa. If you attend school outside of South Africa, omit secondary school details.
School Address:
postal code:
(Table H)
Did you attend any other secondary school before enrolling at your present school? Yes No
Y Y Y YIf yes, in which year did you first enrol at your present school:
If yes, please provide the code of your previous school:
(Table b)
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SECTION K FINANCIAL ASSISTANCE
SECTION I SECONDARY SCHOOL-LEAVING AND POST-SCHOOL INFORMATION
School Address: Date written:
D D M M Y Y Y Y
postal code:
Year Activity code (Table F) Year Activity code (Table F)
Y Y Y Y Y Y Y Y
Y Y Y Y Y Y Y Y
Tertiary Institution code (Table G)
Y Y Y Y Y N
Y Y Y Y Y N
Y Y Y Y Y N
Y Y Y Y Y N
Y Y Y Y Y N
Y Y Y Y Y N
Y Y Y Y Y N
complete this section if you have already left school. Supply only details of secondary schools located in South Africa. If you attended school outside of South Africa, omit secondary school details. please enclose certified copies of your certificates.
last SchoolAttended:
School code:
Qualification completed
Degree/Diploma for which registered
Year of Registration
(Table c)
(Table b)
DETAILS OF ACTIVITIES SINCE LEAVING SCHOOL OTHER THAN TERTIARY EDUCATIONIf you have left school and are not at a tertiary institution, you must complete this section.
TERTIARY EDUCATION DETAILSIf you have attempted any tertiary education or are currently registered at a tertiary institution, you must complete this section. please enclose original transcripts or certified copies of your certificates/result statements.
SECTION J HOUSING APPLICATION
I wish to apply for student housing: I do not wish to apply for student housing:
please tick the appropriate box to apply for UcT accommodation. (See 2018 Directions for Undergraduate Applicants, page 15)
Nb: We do not guarantee accommodation for all students.
NoTE: All UcT financial assistance and NSFAS applications for funding is managed by NSFAS. Apply directly to NSFAS at www.nsfas.org.za and submit all the supporting documents to enable the easy processing of your application. The closing date for financial assistance will be available on the NSFAS website.
I intend to apply for UcT / NSFAS financial assistance: I do not wish to be considered for student financial assistance:
please tick the appropriate box to apply for student financial assistance. (See 2018 Directions for Undergraduate Applicants, page 15)
If you are at school, applying for admission to the MBChB programme, and you wish to submit the Personal Report, detach this page, which must be submitted separately.
physical Home Address:
postal / Zip code:
Tick if offered by school
Grade 10
Grade 11
Grade 12
comment briefly (if you wish) e.g. if more than one team / organisation under e) and f) city / town, province & postal code of primary school:
a) Head girl / boy
b) Deputy head girl / boy
c) School prefect / Student council
d) Hostel prefect
e) captain of sports team/s
f) Vice-captain of sports team/s
g) Editor of a school newspaper
h) Head of debating club
i) Mentor of fellow students
j) class representative
k) list other leadership positions inside or outside of school
TIcK IF YoUR HoME ADDRESS IS IN oNE oF THESE: city/Metro Town Urban Township Rural Village/Farm
SECTION L PERSONAL REPORT FOR ALL MBChB APPLICANTS
1. BIOGRAPHICAL DATAFirst name/s:
2. SCHOOL DATAa) Name of last high school attended: city / town, province & postal code of high school:
Surname / last Name:
Applicant number or SA Identity number or passport number:
library Sports Fields
Science laboratory/ies
computer Facilities
clubs and Societies
b) Did your last high school offer these facilities? (Tick block)
3. LEADERSHIP POSITION/S (ONLY WHILE AT HIGH SCHOOL) Please tick where appropriate please note: one can show leadership qualities in many ways, formally and informally. If your school did not offer the positions below please feel free to elaborate in section k. If your school principal is unable to verify your entry, please supply a letter from a person of authority in your community who would be able to verify your entry.
If you are at school, applying for admission to the MBChB programme,and you wish to submit the Personal Report, detach this page, which must be submitted separately
province
Dialling code: Telephone Number:
Dialling code: cell / Mobile Number:
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SECTION L Continued
4. COMMUNITY SERVICE / VOLUNTARY WORK DURING HIGH SCHOOL YEARS (in and outside of school) Notes: (1) Attach oRIGINAl SIGNED letters confirming involvement for activities outside of your school. You will not be given marks for activities outside of your school if you do not submit evidence of such involvement. (2) please do not use AcRoNYMS, write out the names of organisations and describe what you did while you were a member.
6. SPORTING ACTIVITIES INSIDE OR OUTSIDE SCHOOL, DURING YOUR HIGH SCHOOL YEARS (Attach proof of club / provincial / national level activities outside of school)
7. WHAT OTHER ACTIVITIES OR ACHIEVEMENTS DURING YOUR HIGH SCHOOL YEARS OR AFTER GRADE 12 DO YOU WISH TO HIGHLIGHT THAT YOU FEEL TAUGHT YOU LIFE SKILLS OR ARE RELEVANT TO YOUR APPLICATION? For how long did you take part in this activity? Attach oRIGINAl, SIGNED proof from organisation or a letter from a person of authority who is not family if this is not a school activity, such as a church leader. please note: one can learn life skills in many situations. For example, taking care of an ailing parent or grandparent or of siblings, working as a waiter or waitress. please feel free to enter any activity that you think taught you life skills, inside or outside of school.
8. VERIFICATION BY SCHOOL PRINCIPAL OR HIS/HER DELEGATE OF ACCURACY OF SCHOOL ACTIVITIES LISTED IN SECTIONS 2 TO 7
Did your school organise this (S)or is this an activ-ity outside of your school which you started on your own?
Have you attached proof of your involvement in activities outside school?(YES or No)
a) Give details of any oTHER contribution you may have made to your school or community during your high school years, and indicate when you took part in this activity.
5. CULTURAL ACTIVITIES, CLUBS, SOCIETIES ETC DURING HIGH SCHOOL YEARS (in or outside school) E.g. church school or other choir; musical instrument, debating society Attach original signed letter of proof for each activity outside your school.
Is this activity offered by your school (S) or an organisation outside of your school (oS)?
Have you attached proof of your involvement in activities outside school?(YES or No)
list up to 3 sports in which you participated regularly while at high school Have you attached
proof of your involvement in activities outside school?(YES or No)
In which grade / s ( tick) 10: 10: 11: 12: 10: 11: 12: 10: 11: 12:
At which level did you participate?
(i) Social (outside school)
(ii) club (outside school)
(iii) School
(iv) provincial or National
Describe any exceptional achievement
NAME please sign to show that you are able to verify all school activities
poSITIoN (e.g. principal) ScHool STAMp
TElEpHoNE NUMbER
SIGNATURE
page 6 of 15
If you are at school, applying for admission to the MBChB programme, and you wish to submit the Personal Report, detach this page, which must be submitted separately.
physical Home Address: province:
Dialling code: Telephone Number:
Dialling code: cell / Mobile Number:
postal / Zip code:
TIcK IF YoUR HoME ADDRESS IS IN oNE oF THESE: city/Metro Town Urban Township Rural Village/Farm
If you are applying for admission to the MBChB programme and have attempted tertiary studies,you may wish to submit a CV. Detach this section and submit it separately.
SECTION M CURRICULUM VITAE FOR ALL MBChB APPLICANTS WHO HAVE ATTEMPTED TERTIARY STUDIES
In a CV of not more than 300 words, give an account of your extra-curricular activitiesAT and SINCE leaving school.We would be interestedin LEADERSHIP POSITIONS, all forms of COMMUNITY ENGAGEMENT, team or individual SPORTING ACTIVITIES, CULTURAL ACTIVITIES, SPECIALACHIEVEMENTandOTHERINTERESTS/HOBBIES. Pleasesupplysupportingdocumentationwherepossible,andthecontactdetailsofpersons inpositionsofauthority(whoarenotrelatedtoyou)whoareabletoverifyinformationinyourCV.
Applicant number or SA Identity number or passport number:
2. SCHOOL DATAa) Name of last primary school attended: city / town, province & postal code of primary school:
b) Name of last high school attended: city / town, province & postal code of high school:
library Sports Fields
Science laboratory/ies
computer Facilities
clubs and Societies
c) Did your last high school offer these facilities? (Tick block)
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SECTION M CURRICULUM VITAE
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If you are at school, applying for admission to the MBChB programme, and you wish to submit the Personal Report, detach this page, which must be submitted separately.
Bachelor of Arts (Fine Art) applicants: You must detach and return the completed form with your portfolio
Home (Street) Address: Dialling code: cell / Mobile Number:
Dialling code: Telephone Number:
postal / Zip code:
FOR OFFICE USEApplicant Number:
1. BIOGRAPHICAL DATAFirst name/s:
Surname / last Name:
SECTION N FOR BACHELOR OF ARTS IN FINE ART APPLICANTS
E-mail Address:
Date of birth: D D M M Y Y Y Y Sex: Male Female
HIGH SCHOOLEnter the high school subjects that you are writing, or have completed, and the symbols you achieved in your last examination.
Subject Grade Subject Grade
Date finished school: D D M M Y Y Y Y YES No
POST SCHOOLIf you are not at school this year please complete the following section:
Will you qualify for eligibility to do degree studies (or have you previously qualified to do so)?)
Give detailed information of what you have done since leaving school on a separate sheet.
The portfolio submitted with this form is my own work:
Signature of Applicant:
SECTION N FOR BACHELOR OF ARTS IN FINE ART APPLICANTS continued
D D M M Y Y Y Y
STATEMENT Write a motivation (250-500 words) why you want to study Fine Art, and indicate your future goals.
page 10 of 15
If you are at school, applying for admission to the MBChB programme, and you wish to submit the Personal Report, detach this page, which must be submitted separately.
1. landscape Architecture 2. city and Regional planning 3. Urban Design 4. Architecture
page 12 of 15
page 13 of 15page 12 of 15
If you are at school, applying for admission to the MBChB programme, and you wish to submit the Personal Report, detach this page, which must be submitted separately.
IF YoUR SpoUSE IS AN AlUMNUS / AlUMNA, plEASE GIVE
IF YoUR MoTHER IS AN AlUMNA, plEASE GIVE HER
IF YoUR FATHER IS AN AlUMNUS, plEASE GIVE HIS
IF YoUR bRoTHER oR SISTER IS AN AlUMNUS / AlUMNA, plEASE GIVE
EVEN IF YoU HAVE NoT YET obTAINED SoME oF THE cERTIFIcATES MENTIoNED AboVE, plEASE SUbMIT THIS ApplIcATIoN FoRM NoW.
SEND THE cERTIFIcATES WHEN YoU REcEIVE THEM, QUoTING YoUR AcADEMIc pRoGRAMME cHoIcE(S) AND ApplIcANT NUMbER.
Have you entered your NbT registration number in Section A? .....................................................................................
Have you completed all pages of this booklet? ...........................................................................................................
Have you signed Section Q? ....................................................................................................................................
Has your parent/legal guardian signed Section Q? ......................................................................................................
Have you filled in your correct birth date? ..................................................................................................................
If you have completed your schooling, have you enclosed certified copies of your certificate? ........................................
If you have attended a higher education institution, have you enclosed an original transcript and certificate of conduct? ........................................................................................................................
BA Fine Art: Have you detached the bA (Fine Art) Form, so that you can submit it with your portfolio by the preferred date of 31 August 2017 or the final date of 29 September 2017 ..........................................................
BAS (Architectural Studies): Have you detached the bAS (Architectural Studies) Form, so that you can submit it with your portfolio by the preferred date of 15 July 2017 or the final date of 29 September 2017. ...............................
Health Sciences: If you plan to submit the personal Report Form or a cV, have you detached it, so that you can submit it with supporting documents by 29 September 2017? ..............................................................
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SECTION R DECLARATIONS BY APPLICANT AND PARENT / GUARDIAN
Without prejudice to the terms of my application for admission, I make the following declarations:
1. I will abide by the University’s rules.
2. I hold myself responsible for: the payment of all fees and charges due and payable by me to UCT each year; any arrears and interest on arrears
as defined in this year’s fee booklet; and any costs of recovery, including attorney-and-client scale fees and/or collection commission. If I do
not inform the Registrar in writing of withdrawal from studies or a course by the prescribed date(s) I will be liable for full fees even if I do not
make use of UCT facilities.
3. I accept, agree and understand that: UCT may keep and process data and documents in electronic format, including the personal data
supplied by me in my application form and in this registration form, and my image and fingerprints (both to be used solely for identification
purposes); UCT may use and transfer such data and use such documents in electronic or other formats for UCT purposes consistent with UCT’s
relationship with me as a student and former student including submission of data for the National Learners’ Record Database and other returns
as required by the Department of Higher Education and Training; that UCT places records of qualifications awarded in the public domain; that
UCT may process my personal information in accordance with its rules and policies for academic and administrative purposes, including
disciplinary processes and that UCT may use electronically generated documents in place of the originals signed by me.
4. I waive all claims against UCT for: any damage or loss suffered while I am, or as a consequence of my being, a UCT student and/or arising out
of loss or destruction of, or damage to, any property belonging to me or any other person.
5. I have not been expelled, rusticated, or excluded from any other University.
6. If I am a minor, I have the consent of my parent(s) / guardian to sign this form.
7. The information given on this form is complete and accurate.
Signature of Applicant:..................................................................................... Date: D D M M Y Y Y Y
DEclARATIoN AND SURETYSHIp bY pARENT oR lEGAl GUARDIAN
If you are under 18, your parent/legal guardian must make this declaration. If you are 18 or older and your parent/legal guardian will be paying your fees, your parent/legal guardian must make this declaration.
Details of parent / guardian. (PLEASE PRINT)
Signature of parent / legal Guardian: ........................................................................... Date: D D M M Y Y Y Y
I agree and consent to the above declaration, undertakings, waiver and indemnity by the applicant. I consent to the applicant signing reg-istration forms if admitted. I hold myself jointly and severally liable with the applicant as co-debtor for all amounts due by the applicant to the University, until I notify the University to the contrary, in which event such cancellation shall take effect only from the beginning of the following academic year. I consent to the University holding and processing personal information supplied by me in this application (including any application for financial aid) for purposes related to this application.
* Note: An applicant under the age of 18 must have this form signed by either of his/her parents. Where an applicant has no parents (e.g. they are deceased) or the parents are divorced, a legal guardian is normally officially appointed. In such cases the legal guardian must sign this form. If you do not have a parent or legal guardian, a responsible adult family member (next-of-kin) or other responsible adult who is prepared to make the declaration and the undertaking, must sign with you.The details of this person must be listed under the parent/guardian section on this form. (Section E)
postal Address: country Tel code: cell / Mobile Number:
Identity / passport Number of parent / Guardian:
postal / Zip code:
Title (Table H): Surname / last Name of parent / Guardian:
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