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APPLICATION FORM
Please complete and submit this form to apply to attend the 32nd Chris Engelbrecht Summer School, taking place at the Alpine Heath Resort and Conference Centre, Drakensberg, South Africa from 31 March to 7 April 2023.
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* Indicates required question
Email
*
Your email
Title
*
Miss
Mrs
Ms
Mr
Mx
Dr
Prof
Last name (or Surname/Family Name(s))
*
Your answer
Full first names (as it appears on your official identity document)
*
Your answer
Preferred name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Non-binary
Prefer not to say
Ethnicity
*
African
Asian
Coloured
Indian
White
Other
Prefer not to say
Home / first language
*
Your answer
Mobile phone number (or preferred contact number)
*
Your answer
Country of nationality
*
Your answer
Dietary requirements
*
None
Vegetarian
Vegan
Halaal/Kosher
Your highest level of qualification
*
Doctoral degree
Master's degree
Honour's degree
Postgraduate diploma
Bachelor's degree
Other
Current stage of qualification
*
Enrolled for and in early stages of a Master's degree
Enrolled for and in final stages of a Master's degree
Completed a Master's degree
Currently preparing for a PhD
Enrolled for and in early stages of a PhD
Enrolled for and in final stages of a PhD
I already hold a PhD
Other
Main field of qualification
*
Your answer
Field of specialisation
*
Your answer
Affiliation (university / institution where you are currently studying or obtained your PhD)
*
Your answer
Employment status
*
Employed full-time
Employed part-time
Employed part-time and student
Full-time student
Self-employed
Not-employed
Any notes or questions?
We would also appreciate you disclosing if you have a disability that might impact the event, and what your teaching and learning needs may be.
*
Your answer
I would like to apply for financial assistance to attend the Summer School
*
No
Yes
Who will be paying your fees to attend?
*
Myself
My department / institution
My institution / employer
I need a scholarship to attend
Other
A copy of your responses will be emailed to the address you provided.
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