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Tel : +27 (0)11 669 5000 Fax : +27 (0)11 669 5001 Email : info@regenesys.co.za Web : www.regenesys.co.za 0 1
REGISTRATION FORM
Microsoft4Afrika Scholarship
A) Registration for Academic Course Name of programme you would like to register for:
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(see page 3 for equity code) Mandatory field, ID or Passport Number required. Cannot be left blank (see page 3 for alternative ID code)
Surname Gender M F
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Regenesys Management (Pty) Ltd. is registered with the South African Department of Education as a private higher education institution under the Higher Education Act, 1997. Registration Certificate No. 2000/HE07/02
Regenesys Management 4 Pybus Road, (cnr. Katherine & Pybus), Sandton, South Africa
Tel : +27 (0)11 669 5000 Fax : +27 (0)11 669 5001 Email : info@regenesys.co.za Web : www.regenesys.co.za
REGISTRATION FORM
Employer Information
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REGISTRATION FORM
We are required to collect information on gender and race for statistical purposes only as required by the South African Department of Education Regenesys does not discriminate on the basis of gender, age, disability, race, sexual orientation, colour or ethnic origin. Data collected on this form will be entered into our database. Please ensure that you read the Terms and Conditions. Signing this form indicates that you have read and understood the Terms and conditions. Regenesys will from time to time communicate via SMS or e-mail. Please tick to indicate if this is acceptable. I, __________________________________________ hereby confirm that I have read and accepted the Terms and Conditions (page 4) of Regenesys.
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Neither REGENESYS MANAGEMENT (Pty) LTD nor any of its directors, employees or agents will be held liable for accidents, illness, losses or damage to private property of whatever nature, of registered Regenesys learners.
Codes
Equity Code
Code BA C I/A WH Code 521 527 529 531 533 535 537 538 539 540 541 561 565 Level NQF 4 NQF 5 NQF 6 NQF 7 NQF 8 NQF 9 NQF 10
Alternative ID Type SAQA Member Passport No. or Foreign ID No. Driver's Licence Temporary ID Number None Unknown Student Number Work Permit Number Employee Number HRS Registration No. ETQA Record Number Refugee Number Highest Education Qualification Matric 1st Year (Bachelors Equivalent) 2nd Year (Bachelors Equivalent) Bachelors Equivalent Post Grad Masters Equivalent Doctoral Equivalent
Disability Status Code None Sight (even with glasses) Hearing (even with hearing aid) Communication (talking, listening) Physical (moving, standing, grasping) Emotional (behavioural or psychological) Multiple Disabled (other) Citizen Resident Status Code Unknown South Africa Other Dual (SA plus other) PR Permanent Resident
Code N 01 02 03 04 05 06 07 09 Code U SA O D PR
Code
Employed Unemployed - Looking for work Unemployed - Not looking for work Unemployed - Housewife/Homemaker Pensioner/Retired None of the above N/A: Age <15 N/A: Institution
01 02 03 03 07 10 97 98
Regenesys Management 4 Pybus Road, (cnr. Katherine & Pybus), Sandton, South Africa
Tel : +27 (0)11 669 5000 Fax : +27 (0)11 669 5001 Email : info@regenesys.co.za Web : www.regenesys.co.za