application form: primary school · application form: primary school application for grade _____ in...

Plot21,Brakwater,Windhoek,Namibia

POBox86760,Eros,Windhoek,Namibia Telephone:+264814487274 Mailto:admissions@welwitschia.edu.na

APPLICATIONFORM:PRIMARYSCHOOLApplicationforGrade_________in20___Kindlyattachthefollowing:1. Acertifiedcopyofthebirthcertificateofthelearner.2. Acertifiedcopyofthelearner’slastschoolreport.3. Anymedicaland/orpsychologicalorrelatedreportsavailable.4. Arecentpassportphotoofthelearnerontotheapplicationform,in spaceprovided.5. AcertifiedcopyoftheIDofthepersonresponsiblefortheaccount.6. Recommendationfromcurrentschool(asperattachment).7. Acopyofthelatestmunicipalaccountasproofofresidence.8. TAKENOTE:IfnotborninNamibia,pleasesubmitcertifiedproofofastudy

permit/residencepermit/citizenshipbydescent/domicilecertificate.ADMISSIONWILLNOTBECONSIDEREDWITHOUTALLTHEREQUIREDDOCUMENTATION.ALLAPPLICANTSARESUBJECTTOANINTERVIEW.

FOROFFICEUSEONLYPsychologicalreportreceived YES NOBarrier(s)tolearning YES NOLatestmarksin:Mathematics Higher/Ordinary Marks:English Higher/Ordinary Marks:Afrikaans Higher/Ordinary Marks:Anyotherlanguage: PERSONALDETAILSOFTHELEARNER:SURNAME: _________________________________________________FIRSTNAMES: _________________________________________________PRESENTSCHOOL: _________________________________________________DATEOFBIRTH: DD/MM/YY GENDER:_______________________NATIONALITY: ________________ HOMELANGUAGE:_______________

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NAME(S)OFBROTHER(S)AND/ORSISTER(S)INWELWITSCHIAPRIVATESCHOOL:BROTHER/SISTER:_______________________________ GRADE:____________BROTHER/SISTER:_______________________________ GRADE:____________BROTHER/SISTER:_______________________________ GRADE:____________EXTRA-MURALACTIVITIESANDACHIEVEMENTS:ACTIVITY ACHIEVEMENT

PERSONALDETAILSOFTHEPARENT(S)/GUARDIAN(S):FATHER/GUARDIAN: MOTHER/GUARDIAN:SURNAME:_______________________ SURNAME:______________________FIRSTNAMES:____________________ FIRSTNAMES:___________________IDNo:___________________________ IDNo:__________________________TEL.(H)__________________________ TEL.(H)________________________ (W)_________________________ (W)________________________ (C)__________________________ (C)_________________________POSTALADDRESS: POSTALADDRESS________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________RESIDENTIALADDRESS: RESIDENTIALADDRESS:________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________OCCUPATION:____________________ OCCUPATION:___________________EMPLOYER:______________________ EMPLOYER:_____________________EMAIL:__________________________ EMAIL:_________________________PERSONRESPONSIBLEFORACCOUNTS,WHEREAPPLICABLE:NAMEANDSURNAME:__________________________________________________IDNo:___________________________ CELLNo:________________________EMAILADDRESS:_______________________________________________________POSTALADDRESS:______________________________________________________ ______________________________________________________SCHOOLCORRESPONDENCEMUSTBESENTTO:EMAILADDRESS: ______________________________________________________CELLNUMBER: __________________________

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GENERALINORMATION:1. HostelaccommodationisavailableforlearnersresidingOUTSIDEof

Windhoek.2. Thelearner’shistorywillbeobtainedfromthelearner’spreviousschool

inordertodeterminethelearner’sgeneralbehaviourandacademicachievements.

3. Nodocumentationwillbereturned,pleasekeepyourowncopies.4. Nofaxeswillbeaccepted,onlyapplicationforms.

PLEASENOTECOMPLETIONOFTHISFORMDOESNOTGUARANTEEPLACEMENT.Youwillbeinformedofanofferforplacement.DECLARATIONBYPARENTORGUARDIAN:Ihavereadandunderstoodthecontentofthisapplicationandallinformationsuppliedbymeiscorrect.MychildandIundertaketosubmittotherulesandregulationsoftheSchool.Iapprovethesubjectchoicesofmychild.____________________________ _____________________________SIGNATURE:FATHER/GUARDIAN SIGNATURE:MOTHER/GUARDIAN____________________________ _____________________________SIGNATURE:LEARNER DATE