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					                                      CAPE PENINSULA
                                 UNIVERSITY OF TECHNOLOGY
Cape Town Campus                                                                                                Bellville Campus
P O Box 652                                                                                                     P O Box 1906
CAPE TOWN 8000                                                                                                  BELLVILLE 7535

             Website:www.cput.ac.za

                         APPLICATION FOR ADMISSION: 2005
              Dear Sir/Madam

             We wish to thank you for showing an interest to study at the Cape
             Peninsula University of Technology.

             Enclosed please find the following documents.
             APPLICATION FORM

             Documentation to be submitted.

             Certified copies of:
                 1. Matric certificate or equivalent qualification.
                 2. Your grade 11 (Final) results clearly marked HG/SG on the advice of results.
                 3. Certificate of good conduct (if you are transferring from another Higher Educational Institution).
                 4. Academic record (if you are transferring from another Higher Educational Institution).
                 5. Identity document/ Birth certificate(with ID number)COMPULSORY.
                 6. Application fee is R100, 00 (Postal order or cheque) and the closing date is 31 August 2004.
                 7. You may submit two career choices for this fee. Should you submit two career choices, please attach
                      duplicate certified copies of your documents.
                 8. International academic results to be evaluated by the South African Qualifications Authority
                      (SAQA), before submission. (Tel. +27 +12-4315000)
                 9. A separate questionnaire for RADIOGRAPHY COURSE (ONLY) must be completed, including
                      the application form.


             Please ensure that you complete the APPLICATION form in FULL as per
             INSTRUCTION on page 10 of the application form. ATTACH relevant documents and
             enclose your application fee.

             We look forward to receiving your application.

              Yours faithfully




              Admissions Officer
             Please Note: No student will be allowed to register without an identity document or valid study
             permit (international students)
DEPARTMENT OF HEALTH SCIENCES (Bellville Campus)
(Environmental Health, Nursing, Biomedical Technology &
Radiography)
Dear Applicant

APPLICATION FOR ENROLMENT: RADIOGRAPHY
(NATIONAL DIPLOMA AND B. TECH)

With reference to your application for radiography training, we require further
information in order for your application to be considered.

Please complete the radiography form enclosed, making sure that all sections are
answered fully. Return the completed application form to The Cape Peninsula
University of Technology (Bellville Campus) together with all the supporting
documents, as specified. These must be returned by
31 August.

Applicants for post-graduate studies will be notified whether their application was
successful and details regarding registration. All other applicants will be notified as
soon as possible whether or not they are on the short list of applications. All short
listed applicants will be invited for an interview before the final selection procedure is
completed.

There are many applicants for radiography and of the several hundred who apply
approximately 60 students will be selected. The majority of those accepted are for
Diagnostic Radiography. Approximately 6 students will be accepted for Therapeutic
Radiography, 8 for Ultrasound Radiography and 4 students for Nuclear Medicine
Radiography. These figures are the total number for The Cape Peninsula University of
Technology.

Yours faithfully




MR MS HASSAN
HEAD OF DEPARTMENT
HEALTH SCIENCES
              CAPE PENINSULA UNIVERSITY OF TECHNOLOGY

                     HEALTH SCIENCES – RADIOGRAPHY

                                APPLICATION FORM



       TO BE COMPLETED IN APPLICANTS OWN
       HANDWRITING


1.     PERSONAL (PLEASE USE BLOCK CAPITALS)

1.1    SURNAME                          : ______________________________________

1.2    SURNAME ON MATRIC CERTIFICATE : ______________________________________

1.3    FIRST NAME/S (in full)           : ______________________________________

1.4    POSTAL ADDRESS                   : ______________________________________

                                         ______________________________________

                                          _____________________________________

                POSTAL CODE             : ______________________________________

1.5    TELEPHONE NUMBER

       Home                             : ______________________________________

       Work                             : ______________________________________

1.6    DATE OF BIRTH                    : ______________________________________

1.7    SEX                              : ______________________________________

1.8    IDENTITY NUMBER                  : ______________________________________

1.9    NATIONALITY                      : ______________________________________

1.10   MARITAL STATUS                   : ______________________________________

1.11   HOME LANGUAGE                    : ______________________________________

1.12   CHILDREN

       Number                           : ______________________________________

       Ages                             : ______________________________________
       2.        ACADEMIC


       2.1       SCHOOL LEAVING EXAMINATION: ____________________________________________

       2.2       MONTH WRITTEN                       : ____________________________________________

       2.3       YEAR WRITTEN                        : ____________________________________________




                 RESULTS:         - If you have passed Grade 12 give these symbols.
                 - If you are in your final school year give your Grade 11 results and a copy of
                  your Grade 12 June report.



                                                                   OTHER
      SUBJECTS              GRADE(H/S)       SYMBOL                              GRADE (H/S)       SYMBOL
                                                                   SUBJECTS
  ENGLISH
  (1st/2nd language)
  AFRIKAANS
  (1st/2nd language)

  MATHEMATICS

PHYSICAL SCIENCE

   BIOLOGY




       2.4       NAME OF SCHOOL                           : ______________________________________

       2.5       ADDRESS OF SCHOOL                        : ______________________________________

                                                           ______________________________________


                                                           ______________________________________


                         POSTAL CODE                      : ______________________________________


       2.6       TELEPHONE NO (School)                    : ______________________________________

       2.7       CERTIFICATE                              : ______________________________________

                 (eg Cape Senior Certificate/Joint Matriculation Board)
   2.8      POST-SCHOOL

            COURSE            : ________________________________________________________


            YEAR              : _______________________


         COLLEGE/UNIVERSITY/TECHNIKON/OTHER: _________________________________
                                                               _________________________________


    SUBJECTS WRITTEN                        RESULTS                 SUBJECTS WRITTEN                      RESULTS




            If you did not complete a course, give reason/s:


            ___________________________________________________________________________


            ___________________________________________________________________________


            ___________________________________________________________________________


            Note: Additional information can be given on a separate page if space is not sufficient for
            all courses done.




   3.       EMPLOYMENT (including casual work)

NAME OF EMPLOYER &                                                                           REASON FOR
                                      POSITION HELD                  FROM        TO
TELEPHONE NUMBER                                                                              LEAVING
          Note: If space is not sufficient additional information can be given on a separate page.




4.        HEALTH

4.1       Have you any disability? If so, describe:

          ___________________________________________________________________________


          ___________________________________________________________________________


4.2       Have you had any therapy? If so, explain:

          ___________________________________________________________________________


          ___________________________________________________________________________


4.3       Have you ever had any accidents? If so, describe:

          ___________________________________________________________________________


          ___________________________________________________________________________


4.4       Have you ever had any operation? If so, describe:

          ___________________________________________________________________________


          ___________________________________________________________________________


4.5       Have you ever suffered/do you suffer from problems of any of the following?
                 (Give dates and mention medical treatment)


      •       Eye                    : __________________________________________________
      •       Chest                  : __________________________________________________
      •       Heart                  : __________________________________________________
      •       Rheumatic fever        : __________________________________________________
      •       Back                      : __________________________________________________
      •       Feet                      : __________________________________________________
      •       Headaches/Migraine        : __________________________________________________
      •       Allergies                 : __________________________________________________
      •       Menstruation              : __________________________________________________
      •       Other                     : __________________________________________________

4.6       Have you had more than 5 consecutive days off sick in the past 3 years?

                                        YES                   NO


          If yes, give brief details:
          ___________________________________________________________________________
          ___________________________________________________________________________
5.        GENERAL

5.1       Have you ever been convicted of a criminal offence? If yes, give brief details:

          ___________________________________________________________________________


          ___________________________________________________________________________


5.2       Have you ever been dismissed from employment? If so, when and what for?

          ___________________________________________________________________________


          ___________________________________________________________________________


6.        HOBBIES

          Do you enjoy any hobbies? If so, please mention these:


          ___________________________________________________________________________


          ___________________________________________________________________________


          ___________________________________________________________________________


          ___________________________________________________________________________


7.        EXTRAMURAL ACTIVITIES/INTERESTS

          Do you participate in any sport or social activities? If so, mention these:
      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


8.    RADIOGRAPHY

8.1   The radiography course you are applying for is _____________________________________

8.2   How did you hear about this course? _____________________________________________

      ___________________________________________________________________________


8.3   Have you ever applied for a radiography course before?

                           YES                      NO




8.4   If so, where? ________________________________________________________________

      And when? _________________________________________________________________


8.5   Have you applied at any other education institution/s this year?

                       YES                          NO




8.6   If yes, list the course/s and institutions:

      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


8.7   What is your first choice? ______________________________________________________

8.8   Describe any experience you have had with sick and/or injured people?
      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


8.9   What is your opinion of working in a profession which requires you to work over weekends,
      night-duty and on call?

      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________


      ___________________________________________________________________________




9.    RADIOGRAPHY COURSE

9.1   Please write a paragraph explaining what you know about radiography and the course. Also give
      reasons for selecting this career and this Technikon.



      _____________________________________________________________________________


      _____________________________________________________________________________


      _____________________________________________________________________________


      _____________________________________________________________________________


      _____________________________________________________________________________


      _____________________________________________________________________________
_____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________


___________________________________


I declare that the information given is, to the best of my knowledge, correct. If admitted to the
course, I undertake to abide by the rules of the hospital and technikon.




SIGNATURE OF THE APPLICANT                    : ____________________________________


DATE                                          : ____________________________________




Please complete this application form as soon as possible, and return by 31 July in order to
be considered for selection.
           INDICATE THE HOSPITAL YOU WOULD LIKE TO TRAIN AT BY
           TICKING THE APPROPRIATE BLOCK


           GROOTE SCHUUR HOSPITAL
           (Predominantly English)



           TYGERBERG HOSPITAL
           (Predominantly Afrikaans)


           BY MEANS OF A (√) INDICATE WHAT YOU ARE APPLYING FOR:


               •      DIAGNOSTIC RADIOGRAPHY


               •   NUCLEAR MEDICINE RADIOGRAPHY


               •   THERAPEUTIC RADIOGRAPHY


               •   ULTRASOUND RADIOGRAPHY



   (If you are applying for more than one, please indicate priority 1st, 2nd, 3rd)


           HIGHER STUDIES ARE CONDUCTED MAINLY IN ENGLISH


                                                     FULL-TIME               PARTTIME


B TECH
Indicate Discipline


M TECH
Indicate Discipline


           The following must be included with this application:
1.           Certified copy of Identity Document

2.           Two recent references

3.           The name and contact number/address of two referees

4.           Certified copy of Grade 11 School Report

5.           Certified copy of Grade 12 June School Report
          (September report to be forwarded as soon as possible)


6.           Certified copy of Senior Certificate if you have matriculated

7.           Documents/certificates of post-school study if applicable

8.           Employees references/reports if applicable




     YOU WILL BE NOTIFIED IN DUE COURSE WHETHER YOUR APPLICATION IS
     UNSUCCESSFUL


     OR


     WHETHER YOU ARE ON THE LIST OF APPLICANTS FOR INTERVIEW


     If you are invited to the interview please bring the following with you:


1.           Two passport size photographs

2.           Your most recent school report

				
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