Self Funding – Tulipohamba Training and Assessment Institute

SECTION A: PERSONAL DETAILS

Full Name *

Place of Birth *

Date of Birth *

ID Number(if not a Namibian, Passport required) *

Phone Number *

Email Address *

City *

Region *

Country *

Home Language *

Gender

Marital Status

SECTION B: PROGRAMMES OF STUDY FOR WHICH YOU ARE APPLYING

QUALIFICATION OF STUDY *

SELECT THE COURSE (FIRST CHOICE) *

SELECT THE COURSE (SECOND CHOICE) *

PREFERRED CAMPUS *

MODE OF STUDY *

SECTION C: BACKGROUND INFORMATION

Next of Kin Full Names

Relationship

Phone Number *

Employer's Details (if applicable)

SECTION D: ACADEMIC HISTORY

Secondary Education Details:

Last School Attended *

Year of complition *

Highest Grade

Points *

Tertiary Education Details:

Name of the Institution

Year of completion

Qualification Obtained or Enrolled for

SECTION E: PHYSICAL CHALLENGES AND CHRONIC ILLNESS

Do you have any known disability?

If YES please give more information. Your information will be kept confidential

Do you have any known chronic illness?

If YES please attach a medical report(.pdf only)

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SECTION G: NAME OF SPONSOR

How do you intend to pay for your studies

If Other please state the full details of your sponsor(the entity funding your studies)

SECTION H: ATTACH THE FOLLOWING DOCUMENTS

A copy of a Namibian Identification (ID), Certified by the commissioner of Oath(.pdf only). *

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Full Birth Certificate, Certified by the commissioner of Oath(.pdf only) *

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A copy/copies of school leaving certificate(s) or result statement Grade for 10/ 11/12 Certified by the commissioner of Oath, (this applies to those already with grade 10/11/12)(.pdf only). *

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Application fee, attach proof of payment. *

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