If I Could Turn Back Time

IMPORTANT: Please fax/send/e-mail registration form plus ID document and certified copy of highest qualification.

REGISTRATION FORM
PROGRAMME IN DEVELOPMENT FOR DEVELOPMENT PRACTITIONERS
For office use only
STUDENT NUMBER CERTIFICATE CODE 70017

If you studied at Unisa before, please give your student number Student number
..............................................

Personal details
1. Surname, Initials, Title (eg Smit RJ Mr)
2. First names
3. Maiden name and/or previous surname
4. Date of birth: Year Month Day
5. Male Female
6. Language for correspondence: all correspondence will be in English
7. Identity number
8. Are you physically disabled? (Mark with  ) Yes No
9. Telephone numbers (Dialling code and number): Home.................................................................

Work.................................................................

Fax....................................................................

Cell....................................................................

E-mail................................................................
10. May your name and address be given to fellow students for academic purposes? (Mark with  ) Yes No
11. Postal address and postal code (Block letters - without surname and initials)

Postal code
12. Examination centre code (see attached list)
INFORMATION GIVEN IN QUESTIONS 13-17 IS USED FOR STATISTICAL PURPOSES ONLY
13. Home language 14. Nationality
15. Population group 16. Occupation
17. Economic sector (see attached list)
18. Highest qualification (submit certified copies of original documents) Institution Year
19. Physical address (complete for courier purposes) 20. Your position 21. Nature of your work

22. Briefly state any other qualifications

23. PARTICULARS OF REGISTRATION: Indicate the modules and