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

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Plot 21, Brakwater, Windhoek, Namibia PO Box 86760, Eros, Windhoek, Namibia Telephone: +264 81 448 7274 Mail to: [email protected] APPLICATION FORM: PRIMARY SCHOOL Application for Grade _________ in 20___ Kindly attach the following: 1. A certified copy of the birth certificate of the learner. 2. A certified copy of the learner’s last school report. 3. Any medical and/or psychological or related reports available. 4. A recent passport photo of the learner onto the application form, in space provided. 5. A certified copy of the ID of the person responsible for the account. 6. Recommendation from current school (as per attachment). 7. A copy of the latest municipal account as proof of residence. 8. TAKE NOTE: If not born in Namibia, please submit certified proof of a study permit / residence permit / citizenship by descent / domicile certificate. ADMISSION WILL NOT BE CONSIDERED WITHOUT ALL THE REQUIRED DOCUMENTATION. ALL APPLICANTS ARE SUBJECT TO AN INTERVIEW. FOR OFFICE USE ONLY Psychological report received YES NO Barrier(s) to learning YES NO Latest marks in: Mathematics Higher/Ordinary Marks: English Higher/Ordinary Marks: Afrikaans Higher/Ordinary Marks: Any other language: PERSONAL DETAILS OF THE LEARNER: SURNAME: _________________________________________________ FIRST NAMES: _________________________________________________ PRESENT SCHOOL: _________________________________________________ DATE OF BIRTH: DD/MM/YY GENDER: _______________________ NATIONALITY: ________________ HOME LANGUAGE: _______________ PHOTO

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Page 1: APPLICATION FORM: PRIMARY SCHOOL · APPLICATION FORM: PRIMARY SCHOOL Application for Grade _____ in 20___ ... DATE OF BIRTH: DD/MM/YY ... My child and I undertake to submit to the

Plot21,Brakwater,Windhoek,Namibia

POBox86760,Eros,Windhoek,Namibia Telephone:+264814487274 Mailto:[email protected]

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:_______________

PHOTO

Page 2: APPLICATION FORM: PRIMARY SCHOOL · APPLICATION FORM: PRIMARY SCHOOL Application for Grade _____ in 20___ ... DATE OF BIRTH: DD/MM/YY ... My child and I undertake to submit to the

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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: __________________________

Page 3: APPLICATION FORM: PRIMARY SCHOOL · APPLICATION FORM: PRIMARY SCHOOL Application for Grade _____ in 20___ ... DATE OF BIRTH: DD/MM/YY ... My child and I undertake to submit to the

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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