GAP YEAR 2022 APPLICATION FORM
This is the online application form for The Dome Namibia's Gap Year 2022 Program
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Email *
STUDENT INFORMATION
This section is to be completed by the student
Name *
Surname *
Email Address *
ID Number *
Age *
Gender *
Contact Number *
Physical Address *
Postal Address *
T-Shirt Size *
PARENT/ GUARDIAN INFORMATION
This Section is to be completed by the Parent/Guardian
Name + Surname *
Title *
Contact Number *
Email Address *
Relation to student *
Parent ID (if student is younger than 18 years)
Emergency Contact Number and Name *
Medical Aid Name and Number *
PLEASE ANSWER THE FOLLOWING QUESTIONS (STUDENT)
Why are you interested in this Gap Year Programme? *
Are you fluent in writing and reading in English? *
Do you have your own accommodation and transport? *
Are you certain about which career you want to pursue?
Clear selection
Are you willing to?
1. challenge and shape your thinking and behaviour to allow for personal growth? *
2. actively engage with all activities and values of the gap year programme? *
What would you say you are great at and why? *
What are you passionate about?
For questions about the Gap Year 2022 program or about the application process please email academies@thedomenamibia.com or call +264 (0)81-430-7400
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