LEARNER REGISTRATION FORM

*This form has been designed according to SAQA specifications, refer to look up table for codes
**Please note: A copy of your ID or Drivers License must accompany this registration
***Attach List of Unit Standards for Skills Programmes

1. LEARNER DETAILS
**Click on the        icon for lookup table
* Learner National ID Number:
* Learner Birth Date:
Alternative ID Type:
* Equity Code:
* Nationality Code:
* Citizen Resident Status Code:
* Socioeconomic Status Code:
* Home Language Code:
* Gender Code:
* Disability Status Code:
* Learner Title:
* Learner Last Name:
* Learner First Name:
Learner Middle Name:
* Learner Home Address:
* Postal Code:
* Province Code:
Learner Phone Number:
Learner Fax Number:
* Learner Cell Number:
* Learner E-Mail Address:
2. LEARNER QUALIFICATIONS
* Highest Qualification:
* Year Of Passing:
Other Qualification:
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Qualification Action
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3. NAME AND CONTACT DETAILS OF PERSON RESPONSIBLE FOR ACCOUNTS
* Account Payer Name:
* Payer Occupation:
* Payer Bank:
* Payer Account Number:
* Payer Branch Code:
4. EMPLOYER DETAILS (Where Applicable)
Occupation of Learner :
Company Name:
Employer Code:
Contact Person:
Employer Phone Number:
Employer Fax Number:
Employer Postal Address:
Postal Code:
Work Experience:
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Name Of The Employer Job Title Duration Action
Remove
MEDICAL QUESTIONNAIRE

The workshop, where all practical training activities take place is a high risk area. We will take all reasonable precautions to ensure your well-being. Please complete this section to help us prepare if your training experience with us.

Please provide the contact details of your family doctor.


Name of the Doctor:
Contact Details:
1. Do you have any special needs or suffer from any physical disabilities? * Yes
No
If yes, please provide details:
2. Do you suffer from any chronic medical conditions? * Yes
No
If yes, please provide details:
3. Are there any medical conditions that may affect your ability to participate in the practical learning activities? * Yes
No
GENERAL CONDITIONS
  1. The learner, by his / her signature to this document, agrees to comply with the Training Policy and Code of Conduct for learners of KP Academy.
  2. All learners will be invoiced at registration. Private learners must pay a minimum of 50% on registration. Full payment must be received before the end of the programme.
  3. KP Academy is accredited by the Energy and Water Sector for Education Training Authority (EWSETA). All training and assessments are conducted in accordance with the standards and guidelines of the National Qualifications Framework (NQF).
  4. All disputes that arise will be dealt with in accordance with KP Academy’s Appeals and Disputes Procedures. The learner has the right to appeal against assessment decisions.
DECLARATION

I, Declare that all the particulars furnished by me on this form are true and correct, and I undertake to comply with the conditions, rules, regulations and decisions of KP Academy, and any amendments thereto, which may be applicable to learners in general and the field of learning for which I am registered.


* Signature of Learner:
* Signed On:

In the presence of the undermentioned witness.


* Name Of Witness :
* Signature :
* Date :
CHECKLIST
  1. Please attach the following documents to this application form.
  2. All learners will be invoiced at registration. Private learners must pay a minimum of 50% on registration. Full payment must be received before the end of the programme.
  3. Note that only certified copies will be accepted.

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Documents
Fully completed application form.
Copy of ID
Latest CV
Copy of school leaving qualification
Copy of other qualification
If employed – a letter of appointment or letter from the employer on a letterhead
Any other supporting documents