(Please Indicate): Full-Time

U.24 (SP4)

(2017)

(Please indicate): Full-time

Part- time

Application for the above degree will be considered on receipt of the

following documents:

*Two completed copies of Application Form U.24 (SP4)PASSPORT

*One completed NMMU General Admission Form or Online application

(Not applicable to current NMMU students) SIZE * Written autobiography (no more than 2-3 pages)

*A curriculum vitae PHOTOGRAPH

*Two copies of complete Academic Record

* Two referee reports

*Two certified copies of ID document

#Please complete the forms in full and use block letters

#Mark any section that is not applicable with N.A. STUDENT NO: ......

#Incomplete applications will not be considered

A. / NAME AND ADDRESS

1.TITLE:......

2.INITIALS: ...... 3. SURNAME: ......

4.FIRST NAMES (in full): ......

5.ADDRESS: ......

......

POSTCODE: ...... TELEPHONE NO: ......

CELLPHONE NO: ……………………….E-MAIL: ……………………………………………..

6.MAIDEN NAME (married woman): ......

B. / PERSONAL PARTICULARS (Indicate with a X where applicable)

IDENTITY NUMBER: ...... (PASSPORT NO. in case of foreign applicants)

MARITAL STATUS / Single / Married / Divorced
Widow / Widower
GENDER / Male / Female

HOME LANGUAGE: ......

CORRESPONDENCE LANGUAGE: / English / Afrikaans

PLEASE RATE YOUR LANGUAGE PROFICIENCY AS GOOD/AVERAGE/WEAK:

SPEAK / READ / WRITE
AFRIKAANS
ENGLISH
XHOSA
OTHER (Specify)

DATE OF BIRTH: ......

NATIONALITY: ......

OCCUPATION OF PARENT OR GUARDIAN: ......

C. / OCCUPATIONAL INFORMATION

Have you ever been employed part-time?YesNo

Have you ever been employed full-time?YesNo

If you answered “yes” to any of these questions, please complete the following:

NAME OF EMPLOYER / PERIOD OF EMPLOYMENT / NATURE OF WORK

PARTICULARS OF YOUR LAST / PRESENT EMPLOYER:

NAME : ......

ADDRESS : ......

......

POSTAL CODE: ...... TELEPHONE NO : ......

Briefly describe what your work experience has meant to you, i.e. what you personally learnt from your job/work.

......

D. / ACADEMIC PARTICULARS (Only for applicants who have previous degrees/diplomas and/or applicants from other institutions

DEGREES/DIPLOMAS ALREADY OBTAINED:

DEGREE / DIPLOMA / WHEN OBTAINED
(Month and year) / INSTITUTION
LIST OF COURSES (FOR ABOVE DEGREES / DIPLOMAS) / YEAR LEVEL
E. / ADDITIONAL INFORMATION

LIST YOUR INTERESTS: ......

......

LIST THE RECREATIONAL ACTIVITIES YOU ARE PARTICIPATING IN : ......

......

DID YOU FILL ANY SPECIAL POSITION (e.g. Chairperson, etc.) OTHER THAN THAT OF AN ORDINARY MEMBER IN ANY OF THE SOCIETIES / ACTIVITIES MENTIONED ABOVE? If so, complete:

CLUB / SOCIETY / POST / POSITION / PERIOD

HAVE YOU DONE ANY OTHER COURSES ADDITIONAL TO YOUR ACADEMIC COURSEWORK? (e.g. a counselling course at Lifeline, extra language courses, etc.) If so, complete this section:

INSTITUTION / ORGANIZATION / TYPE OF COURSE / YEAR WHEN
COMPLETED

HAVE YOU HAD ANY OPPORTUNITIES TO APPLY THE SKILLS YOU HAVE LEARNT IN ABOVE-MENTIONED COURSES? If so, please describe:

......

ANY SIGNIFICANT MEDICAL INFORMATION? (Please provide details)

......

WHAT DO YOU INTEND TO DO WITH AN HONOURS DEGREE IN PSYCHOLOGY? WHAT ARE YOUR FUTURE CAREER PLANS?

......

IF YOU ARE SELECTED TO DO THE HONOURS COURSE IN PSYCHOLOGY -

How do you plan to support yourself financially during the year/s of study?

......

Where are you planning to stay during the year/s of study?

......

F. / STUDENT REGISTRATION
HAVE YOU PREVIOUSLY APPLIED FOR THE ABOVE DEGREE AT NMMU? / YES / NO

IF "YES", SPECIFY YEAR: ......

WERE YOU PREVIOUSLY REGISTERED AT NMMU? / YES / NO

GIVE THE NAME/S OF UNIVERSITIES TO WHICH YOU HAVE APPLIED FOR NEXT YEAR

......

ARE YOU OR EITHER OF YOUR PARENTS / GUARDIANS A MEMBER OF THE NMMU STAFF?

YES / NO

IF "YES", STATE1. NMMU DEPT/SECTION ......

2. POSITION ......

SIGNATURE ………………………………. DATE ……………………………

G. / RECOMMENDATION BY HEAD OF DEPARTMENT
1. RECOMMENDED / YES / NO

Full-time: …………………………

Part-time:………………………...

Occasional: ..…………………….

2.IS STATUS RECOMMENDED IN TERMS OF AMENDED HIGH EDUCATION ACT, ACT NO 101 OF 1997?

YES / N.A.

SIGNATURE : ...... DATE : ......

Head of Psychology Department

NelsonMandelaMetropolitanUniversity

FOR OFFICE USE ONLY