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Address

Emergency Contact

Name
Address
This application is for registration for:

If your records have been erased according to the law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of acceptance.

Are you currently or have you ever been charged with or subject to disciplinary action for crime of any kind or any other type of misconduct at any organization?
Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license.

High School Information

High School Address

Please provide the names of people in your immediate family who have attended any of our Training/Academic Program.

Name
Name

Extracurricular, Personal and Volunteer Activities

List your organizations, position, description of the activity, and hours per week of involvement.
List each, a description, the level, and number of years of involvement.
List the type of work, your role, and hours per week of involvement.
List the job, your title, description, hours per week, and dates of employment.
Click or drag a file to this area to upload.

Parent Information

The information requested below is optional, but it may assist in the review of your admission. You are strongly encouraged to complete this section.
Do you have family obligations that might keep you from participating in learning activities?

For Non-South African Citizens Only

Click or drag files to this area to upload. You can upload up to 10 files.

Agreement

By registering for the Erisn Graduate Program, I consent to the collection and use of my personal data for program-related purposes. I agree to abide by all program policies and understand that my participation is subject to compliance with all applicable rules and regulations. Should any information change prior to my entry into the Institution, I will notify the Office of Admissions. I understand that any fee paid is a non-refundable fee.
Do you understand and agree to the terms listed above?
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