Surname*
First Name*
Middle Name (if applicable)
Title*AdvDrMissMrMrsMsProfRev
Identity Type*SAQA Member IDPassport Number or Foreign ID NumberDriver's LicenseTemporary ID NumberSouth African IdentityUnknownStudent NumberWork Permit NumberEmployee NumberBirth Certificate NumberHSRC Register NumberETQA Record NumberRefugee Number
Identity Number*
Passport Expiry Date (dd/mm/yyyy - if applicable)
Date of Birth* (dd/mm/yyyy)
Population GroupAfricanColouredIndianUnknownWhite
Gender*MaleFemale
Nationality*Asian CountriesAngolaAustralia Oceanic CountriesBotswanaEuropean CountriesLesothoMalawiMauritiusMozambiqueNamibiaNorth American CountriesOther & Rest of OceanicRest of AfricaSouth AfricanSADC except SASeychellesSouth / Central AmericanTanzaniaUnspecifiedZaireZambiaZimbabwe
Home Language*AfrikaansEnglishisiNdebeleOtherSouth African Sign LanguagesePediseSothoseTswanaseSwatitshiVendaUnknownisiXhosaxiTsongaisiZulu
Citizenship*Dual (SA plus other)OtherPermanent ResidentSouth AfricaUnknown
Immigrant Status*ImmigrantRefugeeSA Citizen
Socio Economic Status*EmployedUnemployedNot working - not looking for workNot working - Housewife / home-makerNot working - scholar / full-time studentNot working - pensioner / retired personNot working - disabled personNot working - not wishing to workNot working - none of the aboveN/A: Aged < 15N/A: Institution
Disability*Sight (even with glasses)Hearing (even with h. aid)Communication (talk/listen)Physical (move/stand etc)Intellectual (learn etc)Emotional (behav/psych)MultipleDisabled but unspecifiedNone
Occupation (if applicable)
Physical Address*
Postal Address*
Municipality*
Residential Area*UrbanRural
Province*UnknownWestern CapeEastern CapeNorthern CapeFree StateKwaZulu NatalNorth WestGautengMpumalangaLimpopo
Home Telephone Number (if applicable)
Cell Number*
Email Address*
Last Primary/Secondary School Attended*
Last School Year*
Highest Grade Completed*N/AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12
Learner is a Candidacy applicant, Lecturer or non-pivotal Programme applicant.*YesNo
Title of the Highest Qualification Completed*
Certificate: Municipal Financial ManagementFurther Education and Training Certificate: Environmental PracticeFurther Education and Training Certificate: Leadership DevelopmentNational Certificate: Generic ManagementNational Certificate: Information Technology - End User ComputingNational Certificate: Local Economic DevelopmentNational Certificate: Local Government Councillor PracticesNational Certificate: Municipal Integrated Development PlanningNational Certificate: Ward Committee GovernanceNational Diploma: Public Finance Management and Administration
Yes, I do have internet accessNo, I do not have internet access
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