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Seeding Futures
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Name
Surname
Email
Contact Number
Physical Address
Date of Birth
MM
/
DD
/
YYYY
Postal Code
ID/Passport/Birth Certificate number
Nationality
Ethnicity
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Biological Sex
First Language
Other Languages Spoken
Disability and Medical Conditions
Physical, Mental Health, Other
Highest Educational Qualification (Grade)
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Other Qualifications
Next of kin name
In case of emergencies
Next of kin contact number
In case of emergencies
Do you commit to attending class at our venue in Mitchells Plain from 8:30am to 3:00pm, Monday to Friday, for the duration of the course?
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If you are not previously disadvantaged and therefore do not qualify for a course bursary, do you accept the course fee of R4,000?
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A vegetarian breakfast and lunch is provided on the course. Do you have any dietary requirements / restrictions / allergies?
Employment
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Place of employment / Name of Business
Have you ever tried to start your own business? If yes, please describe
Do you have any experience related to this course? If yes, please specify
Have you been involved in any community / environmental / social justice work? Please specify
Why do you want to do this course?
What specific topics are you hoping to learn about?
What do you plan to do with what you learn once you graduate?
What positive personality traits can your course peers count on you bringing to this shared learning environment?
Do you have a criminal record? Arrest or conviction records should be disclosed but are not an absolute barrier to the course, decisions will be made on a case-by-case basis
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Full name and surname as electronic signature
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