The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

UNIVERSITY OF CAPE TOWN: Media, Education & Human Rights Program
Application Form
PERSONAL INFORMATION
First Name
Your answer
Last Name
Your answer
Gender
Required
Date of Birth
MM
/
DD
/
YYYY
Native Language
Your answer
Disability
If you will require accommodations or modification due to a disability, please explain. This will in no way affect your application status.
Your answer
CONTACT INFORMATION
Street Address
Your answer
City
Your answer
State/Province
Your answer
Country
Your answer
Zip/Postal Code
Your answer
Telephone Number
Your answer
Cell/Mobile Telephone Number
Your answer
Email Address
Your answer
PASSPORT INFORMATION
Nationality
Your answer
Passport Number
Your answer
Date of Issue
MM
/
DD
/
YYYY
Expiration Date
*Please note that South African immigration requires that your passport be valid for 30 days after completion of your studies, and requires at least one full blank page.
MM
/
DD
/
YYYY
ACADEMIC INFORMATION
Please fill in the information below for your current academic institution, or the institution you consider your "home" institution if you have attended more than one.
Name of Institution
Your answer
Street Address
Your answer
City
Your answer
State/Province
Your answer
Country
Your answer
Zip/Postal Code
Your answer
Number of Years of Attendance
Your answer
Current Status
Enrolled Degree
Bachelor of Arts, Bachelor of Science, Associates, etc.
Your answer
Major
Your answer
Minor
*if applicable
Your answer
GPA
If not on a standard 4.0 grading scale, please explain
Your answer
PROGRAMME INFORMATION
Programme Applying For
Programme Start Date Applying For
Course Track Applying For
Why do you want to join the program?
Please explain why you are interested in joining The University of Cape Town: Media, Education and Human Rights Programme, and why you are interested in the specific course track? (500 word limit)
Your answer
Financial Information
Please fill in the information below about the person or institution responsible for paying your fees.
Fee Payer
Name of Person Or Institution Responsible for Fees
Your answer
Institutional Point of Contact
If your fee payer is an institution, please fill in the person responsible for managing payment
Your answer
Street Address
Your answer
City
Your answer
State/Province
Your answer
Country
Your answer
Zip/Postal Code
Your answer
Phone Number
Your answer
Email Address
Your answer
ADDITIONAL MATERIALS
As part of your application, please send a digital copy of your academic transcripts, a recommendation letter from an academic faculty member familiar with your work, and copy of your passport (with the expiration date clearly visible) to applications@reel-lives.org. See below for details on naming the documents.
Academic Transcripts
Please title the document "first name_lastname_transcripts". For example, if your name is John Smith, your transcripts should be titled "john_smith_transcripts"
Required
Recommendation Letter
Please title the document "first name_lastname_recommendation". For example, if your name is John Smith, your reference letter should be titled "john_smith_recommendation"
Required
Copy of Passport
Please title the document "first name_lastname_passport". For example, if your name is John Smith, the copy of your passport should be titled "john_smith_passport"
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms