nomination form - Sefako Makgatho Health Sciences
Sefako Makgatho Health Sciences University Interim University Registrar Setlogelo Drive, Ga-Rankuwa, 0208 Telephone: 012 521 3357| Fax: 012 521 3895 Email: [email protected] [email protected] PO BOX 197, MEDUNSA, 0204 SEFAKO MAKGATHO HEALTH SCIENCES UNIVERSITY NOMINATION FOR APPOINTMENT AS A COUNCIL MEMBER This document must be completed by the nominee/applicant for the position of a Council Member. SUBMISSION BY ____________________________ with ID number _______________ 1 NAME OF NOMINEE/APPLICANT 2 FIELD OF EXPERTISE Qualification description 3 ACADEMIC QUALIFICATION/S 1. ……………….. 1. 2. ………………. 2. 3. ………………. 3. 4. ………………… 4. ACCEPTING THE NOMINATION Obtained from which institution ……………… ……………… ……………… ……………… I, ________________________________ with ID number, ______________________ accept the nomination of councilmember of the Sefako Makgatho health sciences university. ______________________________ Signature PLEASE ATTACHED RELATED DOCUMENTS 1 2 3 4 5 6 CV Proof of academic qualifications. Postal Address (FICA) Home Address (FICA) ID Document Banking account Curriculum vitae Bachelor of Arts/Bachelor of Science/ …. etc. Proof of Residence Proof of Residence (Electricity Bill) Certified copy Letter from Bank with official stamp REF: COUNCIL NOMINATION /HJC/FEB2015 Members of the Interim Council: Profe s s or O Shis ana (Chairpe rs on), Ms Sizni Angel Mchunu, Mr Paul Slack, Dr N Simelela, Profes s or A M Se gone , Dr E van Staden
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