INSTITUTE OF PUBLIC ADMINISTRATION OF SOUTH AFRICA (IPASA) A Member of Khoali Group of Companies (PTY) Ltd Application Form FOR SHORT PROGRAMMES AND PUBLIC MANAGEMENT AND ADMINISTRATION FULL QUALIFICATIONS INSTRUCTIONS: 1. 2. 3. 4. Read carefully before completing, signing or submitting this form. Ensure that this form is completed in full. Complete in BLOCK LETTERS. Attach ALL of the following documents: 4.1. Certified copy of a valid South African identity document. 4.2. Certified copy of a valid Senior Certificate (if you have completed Grade 12). 5. Application forms with incomplete information will be disqualified. 6. Applications received after the closing date will not be considered. 7. Application forms with incorrect information will lead to your application being disqualified. 8. No faxed application forms will be accepted. 9. Post completed forms to or hand deliver to: Postal Address PO BOX 5003 DUDUZA 1494 Physical Address 110 8TH STREET SPRINGS 1559 Accreditation: ETDP Seta 10276 Pseta - P21/0913/GP 485 1 SECTION A - PERSONAL DETAILS OF APPLICANT First Name Preferred Communication Method Middle Name Telephone Number (including area code) Surname Cell Number Initials Fax Number (including area code) Email address Title SA ID Number Address Line 1 Date of Birth Gender Address Line 2 Male Female Address Line 4 Equity (for reporting to the SETA’s) Black – African Address Line 5 Coloured Black – Asian/I ndian Postal Code White Eastern Nationality Geographical Area (state SA Province or other) Home Language Citizen Residence Status Disability Status Socio Economic Status IPASA Not Disabled Disabled Employed Unemployed Alternate ID Type Alternate ID Number Highest Education Accreditation: ETDP Seta 10276 Pseta - P21/0913/GP 485 2 SECTION B - HIGH SCHOOL ATTENDED 1. Name of school:_____________________________ 2. School address: _____________________________________ Province:____________________ 3. 4. Last Grade completed:____________ 5. Years attended From: __________To:__________ 6. Subjects (List them below) Subject HG/SG Symbol % SECTION C - POST SCHOOL QUALIFICATIONS (if Applicable) 1. Full name of highest qualification:______________________________ 2. Nature of qualification/ Degree/Diploma ________________________________ 3. Status Presently studying : YES NO 4. If discontinued, for what reasons? ______________________________________ 5. If presently studying, which year of study? 1st 2nd 3rd 4th year 6. Name of institution:______________________________ 7. Student number:_____________________ 8. Address of institution:___________________________________________ 9. Latest results: Subject HG/SG Symbol % NB: Attach proof of latest academic results or academic transcript/s Accreditation: ETDP Seta 10276 Pseta - P21/0913/GP 485 3 SECTION D - INTENDED STUDY FOR THE NEW ACADEMIC YEAR 1. Indicate Unit Standard or qualification applying for: Unit standard title Conduct Outcomes-based Assessments Conduct Moderation of Outcomes-based Assessments Facilitating learning using a variety of given methodologies Plan and prepare for an effective presentation Facilitate an adult learning event Evaluate an intervention using given evaluation instruments Unit Standard 115753 NQF Level 5 Credits 115759 6 10 117871 5 10 242842 4 2 7384 4 16 123397 5 10 15 SAQA ID Qualification Title NQF Level Minimum Credits 50060 National Certificate: Public Administration 5 141 57824 Further Education and Training Certificate: Public Administration 4 146 57804 National Certificate: Public Administration 3 157 Accreditation: ETDP Seta 10276 Pseta - P21/0913/GP 485 Tick Box Tick Box 4 SECTION E – DETAILS ABOUT PARENT(S) / GUARDIAN(S) / NEXT OF KIN 1. 2. 3. 4. 5. Surname: ___________________________ First names:____________________________________ Identity No:__________________________________ Relationship Mother/ Father /Other, specify: _______________________ Residential address: ______________________________________________________________ 6. Postal address ______________________________________________________________ 7. 8. 9. 10. Home telephone:_________________________________ Cellular:_______________________________________ Work Other:__________________________________ Email address:_________________________________ SECTION F – DETAILS ABOUT EMPLOYMENT 1. Current Employer: ___________________________ 2. Position:____________________________________ 3. How long employed :__________________________________ 1. Previous Employer: _______________________ 2. Position:____________________________________ 3. How long employed :__________________________________ Bank details for payment: Khoali Training Institute First National Bank: Springs Branch code: 201509, Account no.: 502 6241 8757, Accreditation: ETDP Seta 10276 Pseta - P21/0913/GP 485 5