Application 2010

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NEMISA

Application Fo . rm 2010
Graphic Design: Radio Production: Television Production:

Course Information
(PLEASE COMPLETE IN BLOCK LETTERS) All courses listed below will be held at NEMISA: 21 Girton Road, Parktown, 2193

Animation:

Applicant’s Information
(PLEASE COMPLETE IN BLOCK LETTERS)

Title:

________ ________________________

Surname:

_____________________________________ ________________________________

First Name:

Middle Name(s):

Residential Address: __________________________________________________________________________________________________ ______________________________________________________________________________________________ Code: ________

Postal Address: _____________________________________________________________________________________________ _______________________________________________________________________________________________ Code: ________ ____________________________ (Work): Fax: _______________________________________

Tel No (Home): Cell: Email:

_____________________________________

__________________________________________

_______________________________________________________________________________________

Enrolment reference:
Educational Qualifications (please tick appropriate box) Grade 12/ NQF Level 4 Qualification Institution: Year obtained: ________

____________________________________

-- Please attach a certified copy of your grade 12/latest results or level 4 certificate --

NEMISA
National Electronic Media Institute of South Africa

NEMISA is an Accredited Training Provider by the MAPPP SETA (Noata7MAPP08013025)

Please send the fully completed application form and the necessary documentation by 30 September 2009 to The Recruitment Officer: 21 Girton Road, Parktown, 2193 or PO Box 545, Auckland Park, 2006 1 By Fax: +27(0)11 484.0615 By Email: Info@nemisa.co.za Telephonic Enquiries to: (011) 484.0583

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NEMISA

Application Fo . rm 2010
_______________________________________________________________________ _____________________________________________________________________________________ ____________years ___________________months

Tertiary Qualification Please mention subjects related to media studies (if any). Degree/diploma/certificate: Institution:

Duration of study:

Year completed: ______________

Degree/diploma/certificate: Institution:

_______________________________________________________________________

_____________________________________________________________________________________ ____________years ___________________months

Duration of study:

Year completed: ______________
-- Attach Certified copies of your degree / diploma / certificate and full academic transcripts are required --

Previous / Current Employment (where applicable)
Name of previous/current employer: Address: __________________________________________________________________

_____________________________________________________________________________________ ) ________________________________ ____________years ______________months

Tel. number: (

Duration of employment:

Designation: ___________________________________________________________________________________ Job description: _________________________________________________________________________________ ______________________________________________________________________________________________
-- Attach a copy of your curriculum vitae/resume with references --

Disability /special needs. Please tick:
Blind Paraplegic Partially sighted Impaired mobility Deaf Dyslexia Partial hearing Cerebral palsied Quadriplegic Learning disability

Other (please specify):___________________________________________________________________________ Would you require assistance from the Disability Unit at NEMISA? If so, please specify ______________________________________________________________________________________________
Kindly supply NEMISA with the above information on your disability status when you submit your application. Failure to do so would limit NEMISA to meet your reasonable assistance form. -- Page 2 of 3 --

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NEMISA

Application Fo . rm 2010
__________________ __________________ _____________________ Rural/Urban: Gender: ____________________________________ _______________________________________ ____________________________________ ____________________________

Information required by South African Qualifications Authority (SAQA)
Province:

Population Group: Home Language:

Nationality:

ID/Passport Number (attach a certified copy of your ID document / Passport): Religious Affiliation: Christian Jewish Islam Jehovah’s Witness

Hindu

None

Other:_________________________________________________________________________________________ Answer the question below as honestly as possible. Why do you want to do a course in Broadcasting or Visual Media Studies - please explain “why this field” is for you? Motivate why you should be accepted into the class of 2010. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Portfolio Requirements (only for learners applying for the Animation & Graphic Design Diplomas)
You are required to attach a few portfolio pieces to your application. If you do not have an Art or Design portfolio, please produce the following art pieces (all drawings to be done in pencil on A3 or A4 size paper; all drawings are to be compiled from observation of real objects/subjects – do not trace, nor copy from pictures. Choose · · · · · three of the following drawings: A still life A portrait of a famous person A full length drawing of a person walking Your own cartoon character A landscape drawing
This form is an application for admission only and is not binding. -- Page 3 of 3 --


				
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Description: Application 2010