APPLICATION ENROLMENT FORM Part time by monkey6

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									PART TIME APPLICATION FORM
PREFERRED CAMPUS: [] SANDTON RESIDENCE [] YES APPLICABLE [] SINGLE or [] SHARING MODULAR CLASSES BEAUTY THERAPHY / AESTHETICIENNE [] Mod 1 – Manual Facials [] Mod 2 – Elec. Treatment Pedicure [] Mod 5 – Waxing [] Mod 6 - Hygiene Studies BODY THERAPHY / PHYSIATRICS [] Mod 9- Anatomy/Physiology [] Mod10 – Swedish Massage Therapy [] Mod13 - Nutrition COMPLIMENTARY THERAPHIES [] Mod14 - Aromatherapy [] Mod15 - Reflexology [] Mod18 – Manual Lymph Drainage Perm Lips/Eye [] Mod 21 - Epilation [] Mod22 – Hot Stone Massage [] Mod23 –Thai Massage Massage [] Mod26 – Pregnancy / Infant Massage Spray / Manual Tanning [] Mod31- Nail Extensions [] SPLIT MODULE COMBINED COURSES [] Total Beauty Care (Module 1- 8) ADVANCED MODULAR [] Spa Management Diploma [] Total Body Care (Module 9- 13) [] Mod28 – IPL (ITEC) [] Holistic Honours Certificate

[] CAPE TOWN [] NOT

[] Mod 3 - Make-Up [] Mod 7 - Science

[] Mod 4 – Mani / [] Mod 8 – Business

PHOTO

[] Mod11- Slimming

[] Mod12 – Exercise

[] Mod16 –Media Make Up [] Mod17 - Shiatsu [] Mod19 – Holistic / H Massage [] Mod20 [] Mod24 – Lomi Lomi [] Mod27 – Teeth Whitening [] Mod25 – Deep [] Mod30 –

[] Mod29 – MDA (ITEC)

PERSONAL
Surname: First Name: ID / Passport No: Home Language: Postal Address: ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ Postal Code: E-Mail Address: ______________________________________ ______________________________________ Postal Code: Cellular No: Initials: Gender: Date of Birth: Second Language: Residential Address: _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ [] Male [] Female

_____________________________________ _____________________________________

(H) ______________________________________ Fax Number: ______________________________________ [] Newspaper [] Magazine [] Web [] Open Day

(W) _____________________________________

How did you hear about the school?

[] Friend [] Other [] Marketing Executive Visit to School

WORK EXPERIENCE
Please indicate your work experience, if applicable

Work Name 1:

______________________________________

Position:

_____________________________________ from to

1

______________________________________

Period Employed:

_____________________________________

EDUCATION
Last School / College Attended: Town / City: _____________________________________ _____________________________________ Qualification: Final Year: ____________________________________ ____________________________________

_____________________________________ Please provide details:

Subjects

Results

PAYMENT
Who will be responsible for your fees?

[] Self

[] Parent

[] Guardian

[] Other

Please provide the following details of your Sponsor

Surname: Company Name: Postal Address:

______________________________________ ______________________________________ ______________________________________ ______________________________________

First Name:

_____________________________________

Physical Address:

_____________________________________ _____________________________________

Postal Code: E-Mail Address:

______________________________________ ______________________________________

Postal Code: Cellular No:

_____________________________________ _____________________________________

______________________________________

Facsimile No:

_____________________________________

PARENT / GUARDIAN DETAILS
Details about your Father, if applicable

Surname: Occupation:

______________________________________ ______________________________________

First Name: Company Name:

_____________________________________ _____________________________________

(H) ______________________________________ Cellular No: E-Mail Address: ______________________________________ ______________________________________ Facsimile No:

(W) _____________________________________ _____________________________________

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Details about your Mother, if applicable

Surname: Occupation:

______________________________________ ______________________________________

First Name: Company Name:

_____________________________________ _____________________________________

(H) ______________________________________ Cellular No: E-Mail Address: ______________________________________ ______________________________________ Facsimile No:

(W) _____________________________________ _____________________________________

SUPPORTING DOCUMENTATION
[] [] [] Grade 11 Report ID Photo Copy of Passport / ID Document

APPLICANT FULL NAMES: ______________________________________________________________________________________________

APPLICANT’S SIGNATURE: ______________________________________________________________________________________________

DATE SIGNED: __________________________________________________________________________________________________________

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