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    Personal Information

    Surname*

    First Name*

    Middle Name (if applicable)

    Title*

    Identity Type*

    Identity Number*

    Passport Expiry Date (dd/mm/yyyy - if applicable)

    Date of Birth* (dd/mm/yyyy)

    Population Group

    Gender*

    Nationality*

    Home Language*

    Citizenship*

    Immigrant Status*

    Socio Economic Status*

    Disability*

    Occupation (if applicable)

    Physical Address*

    Postal Address*

    Municipality*

    Residential Area*

    Province*

    Home Telephone Number (if applicable)

    Cell Number*

    Email Address*

    Last Primary/Secondary School Attended*

    Last School Year*

    Highest Grade Completed*

    Learner is a Candidacy applicant, Lecturer or non-pivotal Programme applicant.*

    Title of the Highest Qualification Completed*

    Select the course which you are applying for

    Do you have access to the internet?

    Workplace Information (if applicable)

    Please attach a copy of your ID/Passport