Kaleidoscope Technology Centre Online Application Form

Our contact details:

Telephone Number: 023342 2313 / 023 348 7630

E-mail:

Fax: 023 348 7633

Postal address: 20 Adderley Street, Worcester 6850

Contact person(s):

Applications: Corné du Bois (023342 2313)

Enquiries: Philip Crouse (023 348 7630)

PLEASE NOTE: All fields must be completed and all additional information and documents must be submitted using the above contact details before your application can be processed.This application is subject to approval. Your place in any course will only be booked after full payment has been received.

You must submit a certified copy of your I.D. with this application.

Accommodation

Accommodation is offered to visiting students, subject to availability. Please email enquiries to and cc and in the message to ensure a prompt response.

Please see contact details for additional accommodation below:

Tolbos Backpackers

Contact: Hector Loftus 072 8877007 / 023 3477148

Da Rooms B&B

Contact: 072 250 7471

The Habit

Contact: 023 3423538

Zonneweelde Guest House

Contact: 023 342 6953

Wykeham Lodge

Contact: 023 347 3467

Section A: Personal details of applicant

Surname:

Full name(s):

ID number:

Date of birth (yyy/mm/dd):

Gender (male/female):

Home address:

Postal code:

Telephone number (home):

Cellphone number:

E-mail address:

Marital status (married/divorced/single):

Please briefly state your educational qualifications:

Please briefly state your current and previous work experience:

Section B: Parent/guardian if student is a minor (under 18)

Relationship to student:

Full name(s) and surname:

Home address:

Postal code:

Home telephone number:

Cellphone number:

Work telephone number:

Section C: Enrolment

Please indicate the module(s) you are enrolling for with "yes" in the field next to the course number and name below.

IOS (iPhone / iPad)

Module 1: Getting started using VoiceOver and Zoom:
Module 2: Communication:
Module 3: Time management:
Module 4: Applications for the blind:

Mac User Essentials

Module 1: The Mac system using VoiceOver and Zoom:

Module 2: Core applications:

Do you want to receive training on VoiceOver/Zoom/Both? Please specify:

Cost per module:

IOS - R1500.00 per module before commencement of training.

Mac User Essentials – R3750.00 per module before commencement of training.

Is the student responsible for own tuition (yes/no)?

If no, please state the full details of the company/person responsible for tuition:

Registered name of company:

Name and surname of responsible person:

Position:

ID number:

Postal address:

Postal code:

E-mail address:

Telephone number:

Section D: Previous experience

IOS

Do you own an iPhone / iPad? If yes, please state which:

Have you used an iPhone / iPad before? If yes, please describe briefly:

Mac User Essentials

Have you used VoiceOver / Zoom previously on a Mac? If yes, please describe briefly:

Do you blind-type 20 words/min or more?:

Please Note: This course is not for beginners. The minimum requirement to qualify for training is a typing speed of 20 words/min and previous relevant computer experience.

Do you have computer experience? If yes, please Give a detailed description:

Do you use a computer at work? If yes, please describe:

Communication

Do you speak fluent English? Please describe:

Other disabilities

Do you have any other disabilities? If yes, please describe:

Section E: Payment details

Please note: payment is due in full before commencement of training.

You may make payments directly into our bank account. Should you not be able to pay the amountin full in advance, please contact us to make alternative payment arrangements.

Bank / Absa, Worcester
Takkode
Branch Code / 632 005
Rekening Naam
Account Name / Instituut vir Blindes / Institute for the Blind
Rekening Nommer
Account Number / 0440 159 087
Stuur bewys na
Send proof of payment to / Fax:+27 (0) 23 347 3665
Vir Aandag / ATT: Belinda Coetzee

Verwysing
Reference / TECH & student se naam
TECH & student’s name