ATTACH
YOUR
PASSPORT
/PHOTO
HERE!
Office No. B7 Noorani (Madina) Complex
Between Old UIF and Bus Rank Thohoyandou
P.O. Box 2350 Thohoyandou 0950
Tel/Fax: 015 962 1073 ,Cell: 082 207 9100/ 082 766 7662 /082 064 6984
e-mail: [email protected]
Website: www.protechcollege.co.za
REGISTRATION FORM 2015
Your registration will only be considered if this form is accompanied by admin
fee, registration fee and statement of results / school report (Grade 9-12)
1. PERSONAL DETAILS:
Please complete the following in full print and if at anytime the information below changes, you are
required to notify the campus immediately:Title………..Names………………………………….…………………...Surname……………………………...
Residential Address:………………………………………………………………………………….……………
Postal Address:………………………………………………………………………………….Code…………..
Date of Birth: …………… Age……...Gender (please tick) M
ID NO:
F
Home language………………….
Correspondence (please tick) English
Race (Required by government for statistics purpose) African
Colored
White
Afrikaans
Indian
other
Tel No: (H)……………………………...Tel No: (W)…………………………..Cell: ………………………….
Name and Tel of next of kin…………………………………...How did you hear about us?................................
Highest standard passed :…………………………………School/Institution: …………………………………
Qualification ……………………………………Where obtained (Institution studied at) ………………………
Extra Mural Activities……………………………………………………………………………………………
Employer……………………………………….Cell No………………….E-mail address………………………
Fax No:………………………………………………Contact Person………………Designation……………….
2. COURSE DETAILS:
I hereby apply to enroll for the following courses as a student of Professional Technical College.
Please list modules that you requireCourse Contents…………………………………………………………...……..Time slot…...…………….
Course Contents:
1)…………………………………………………………….. 5)…………………………………………………………….. 9)………………………………………………………………
2)…………………………………………………………….. 6)…………………………………………………………….. 10)……………………………………………………………
3)…………………………………………………………….. 7)…………………………………………………………….. 11)……………………………………………………………
4)…………………………………………………………….. 8)…………………………………………………………….
12)…………………………………………………………...
Date of Registration…………………Date of Commencement …………….Date of Completion………………
3. PERSONAL REFERENCE (A FRIEND OR RELATIVES NOT LIVING WITH YOU)
Name (s)…………………………………………………………………………………………………………...Surname……………………………………………………………
Physical Address ………………………………………………………………………………………………………………………………………………...…………………….
.…………………………………………………………………………………………………………………………………………………………………….…
Postal Address ………………………………………………………………………………………………………………………………………………….Code………………..
Tel (H) ……………………………………………………………(W)……………………………………………...E-mail…………………………………………………………….
4. PAYMENT DETAILS OF GUARANTOR
If a student is under 21 years of age or unemployed, please ensure that the parent or guardian completes the following:Title: ………………….First Name (s)…………………………………………………………………….Surname ………………………………………………………………
ID NO:
Relationship with a student………………………………………………………………………
Physical Address ……………………………………………………………………………………………………………………………...………………………………………….
………………………………………………………………………………………………………………………………………………………………….……..
Postal Address: ………………………………………………………………………………………………………………………….Code………………………………………….
Tel (H)……………………………………………………………………………(W)……………………………………………………..(e-mail)……………………………………..
5. CLOSING DATE FOR REGISTRATION
In order to ensure adequate time for registration, applications for admission in the year 2015 are scheduled as follows:-
PROGRAM
REGISTRATION
CLOSING DATE
Ncv / Grade 12
Now open
14 / 01 / 2015
Engineering Studies
Now open
19 / 01 / 2015
Commerce
Now open
26 / 01 / 2015
Computer Studies
Open for 2015 Academic Year
Skills / Phases
Open for 2015 Academic Year
An application received after the closing dates indicated above, will be charged of R250 late registration fee.
Spaces are limited and it is therefore advisable to possible students to register in time.
6. PAYMENT DETAILS
FULL PAYMENT
METHOD OF PAYMENT (Please Tick one)
Cash
Cheque
PayPal
EFT
Banking Details:
Account Holder : Professional Technical College
TOTAL
Bank
:FNB
OR
:ABSA
Account No.
:54660035543
I
:4054728834
Branch
: Thohoyandou
I
:Thohoyandou
7. APPLICATION FEES FOR ACADEMIC YEAR 2015
The admin fee is R550 which is non-refundable.
8. TERMS AND CONDITION OF ENROLMENT
1.
If a student exceeds the duration of the course, an amount of R500 will be charged within the period of three months
thereafter.
2.
I understand that monthly/quarterly payments will be made on or before 7th day of every month in advance. Note that
15% penalty will be charged on the late payment.
3.
A further 15% will be charged on the whole remaining balance where the candidate has failed to settle within the agreed
period and therefore a parent / guarantor would be obliged to sign the acknowledgement of debt form.
4.
I understand that Professional Technical College reserves the right to change the courses content without notice.
5.
I understand that the admin fee plus the registration fee or deposit should be paid in full prior to commencement of the
course
6.
Money paid to Professional Technical College are not refundable under any circumstances.
7.
I accept that the money paid to Professional Technical College by me towards my course are not transferable.
8.
Wearing of hats by male students inside the school premises is strictly not allowed, earrings as well as any form of piercing
is also not allowed on male students.
9.
No student shall be allowed to smoke and or drink alcohol substances inside the school premises.
10. I agree to have legal proceedings instituted against me for the recovery of any outstanding amount which is due or over
due in accordance to this terms and conditions.
11. I understand that should I withdraw from the course without immediately enrolling for another , my legal guardian/
parent will be liable to pay 100% of the course fee. This is also applicable to students who are paying tuition fees on their
own accord.
12. I agree that I will not divulge or, communicate this arrangement to any person or use it to explore it for any purpose or
whatsoever or any confidential information which may have come to my acknowledge by reason of, or in connection with
the course I am doing.
13. I will be responsible for any damage caused by myself upon property, equipment etc. and I will be liable to pay for any
damage or labour cost incurred and failure to do so may lead to legal action taken against me.
14. I am expected to demonstrate reasonable standard of conduct and failure to do so may result to my expulsion from the
campus and I will forfeit all payments made.
15. All bank guaranteed cheques are payable to Professional Technical College.
16. Transfer from one campus will constitute a transfer fee of R200.00.
17. In the event of branch closing down or relocating, all students will be transferred to the nearest campus without any additional costs or compensation.
18. Fees charged by Professional Technical College include all internal and external examinations but exclude supplementary
examination fees.
19. Course material and study notes are recommended and will only be supplied to students upon request and availability.
20. The guarantor of the above mentioned student hereby, upon the appending of his/her signature have to be surely that he/
she is the co-principal debtor with the aforementioned applicant for the fulfillment of all his/her obligation in terms of the
agreement including the payment, for all the course fees.
21. Cancellation of any specific module within the course will not affect the stipulated tuition fees which are attached to the
course after registration.
22. This application is subject to acceptance by Professional Technical College and may not be cancelled once it is registered.
23. Students will only proceed to seat for the exams upon fully paying the tuition fees of the respective trimester/ semester
and no student will seat for the exams if owing any amount to the college.
24. All students are required to have valid driver’s licenses before they complete their N6 National Certificate or Diploma.
Driving lessons and learners license fees are payable in 6 or 12 months resolving plan.
I, the undersigned hereby command that all the information supplied herein is true and correct. I further
acknowledge that I fully understand and agree the terms and condition as outlined:Name of Student………………………………………………………...Signature…………………………..
Signed at ………………………………………………on the ……………day of ……………….20……….
Name of guarantor/ guardian …………………………………………..Signature …………………………..
Name …………………………………………… Signature………………………Date……/……../20…..
Applicants may hand in, Fax or Email the completed registration form to 0867662864 or [email protected]