FOR OFFICE USE ONLY

APPLICATION FOR ADMISSION TO

MASTER’S AND DOCTORAL DEGREES
Other than Pharm D / MBA or degrees in Psychology (for which separate forms are available).
http://www.ru.ac.za/administrative/registrar/forms/

Year of admission

LAST NAME:
FIRST NAMES (in full):

MAIDEN NAME (if applicable):

TITLE (Mr, Ms, Miss, etc): INITIALS:

Population group (required for statistical purposes):  African Coloured Indian White

Home language:

Are you a South African citizen? ü Yes No If “NO”, are you a permanent resident? Yes No

If not South African citizen, state nationality:

SA identity number or passport number:

DD MM YY

Date of birth:

Have you ever been registered at Rhodes? ü Yes No

Student No:
Are any of your immediate family Old Rhodians?
(e.g. mother, father, siblings etc) Yes No
Please 
 where relevant

NAME: _____________________________________ Student No:

NAME: _____________________________________ Student No:

Are any of your immediate family currently registered at Yes No
Rhodes? ü

If “YES” please give their student number(s)

Please indicate any disability: ü

A Diabetic B Blind C Cerebral Palsy
D Deafness E Behavioural/Psychological H Partial Hearing
I Partially Sighted L Intellectual (Learning Difficulty) P Paraplegic
Q Quadriplegic S Speech Defect T Communication (Talking/Listening)
W Wheelchair Y Dyslexia Z Physcial (Moving/Standing/Grasping)
U Unspecified M More than one disability
You are required to provide this information about your disability at the time of your application. If
you do not, the University cannot undertake to provide reasonable assistance.

PROPOSED REGISTRATION

Full-time ü Part-time

In attendance? ü Yes No

Choice of degree (e.g. MA) ____________________ in the Department of _________________________

Subject _________________________________________________________________________________
(Applications for MA in Creative Writing should be accompanied by a 20-page portfolio of creative work)

Degree by ü Research thesis Coursework and thesis/research project Coursework only

Proposed supervisor (if you have one): _______________________________________________________

Proposed field of research or thesis title: ____________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________
(For MA in Creative Writing please indicate the genre of writing, e.g. novel, poetry book or play)

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ADDRESS DETAILS
HOME POSTAL ADDRESS: DIALING CODE: TELEPHONE NUMBER:

DIALING CODE: FAX NUMBER:

POSTAL CODE: CELL:

E-MAIL:
HOME STREET ADDRESS:
NB ALL future correspondence will be sent to your email
address. Hard copies of specific correspondence will be
supplied on request. It is essential that you keep the
University informed of your current email address.
POSTAL CODE:

Next of kin: ü Father Mother Partner Other None

Title, initials & last name of next of kin: ____________________________________________________

NEXT OF KIN (PHYSICAL ADDRESS): DIALING CODE: TELEPHONE NUMBER:

DIALING CODE: FAX NUMBER:

POSTAL CODE: CELL:

E-MAIL:

Title, initials, last name of person responsible for fees. If self leave blank: ________________________

________________________________________________________________________________________

Account address. If the same as the home postal address, leave blank: ___________________________

________________________________________________________________________________________
RESIDENTIAL ACCOMMODATION

Do you wish to stay in a University residence?: ü Yes No I am already in residence

House of 1st choice _____________________(may answer “ANY”) 2nd choice: _____________________

There is no guarantee of accommodation in a preferred residence.

ACADEMIC QUALIFICATIONS

Please give details of the last higher education institution that you attended.

University/institution: _____________________________ Student Number: ________________________

Degree/qualification: _________________________ Degree/qualification completed? ü Yes No

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All postgraduate applicants are required to submit with the application form a full official
academic transcript reflecting the detailed results, including percentage marks, of all previous
qualifications and the award of degree(s). Copies of degree certficates do no consitute an
academic transcript.
Applicants who at the time of application are completing a degree requisite for admission, should
submit all available academic results on application, with submission of the full/final academic
transcript as soon as this is available. Rhodes students do not need to submit Rhodes transcripts.

Married women: where your previous qualifications are in your maiden name, please supply a
copy of your marriage certficate for record purposes.

Have you attached your academic transcripts? ü Yes (if not your appliction cannot be considered.)

Have you attached your deposit slip or proof of payment of the application fee? ü Yes No

NB: DO NOT NEGLECT TO SIGN THE DECLARATION AND AGREEMENT ON THE NEXT PAGE
THE FORM WILL BE RETURNED IF IT IS NOT SIGNED.

BANKING DETAILS FOR RHODES UNIVERSITY

FNB Bank Grahamstown

Account Name: Rhodes University
Account Number: 62145504553
Branch Code: 210-717
Swift Code: FIRNZAJJ

Attach a copy of the Deposit Slip to this Application Form.

OFFICE USE ONLY

DATE SIGN
1. Captured
2. Form Checked

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 DECLARATION AND AGREEMENT

I/We, the undersigned, hereby declare that:

To the best of my/our knowledge and belief the information furnished in this application is true and
correct and that if it be found to be false, and misleading in any respect, this application may be
invalidated and the applicant’s registration terminated; and further agree:

That I/We accept liability for damage to University property howsoever caused by the Applicant and
indemnify the University against any loss or damage howsoever caused in respect of property left at
the University by the Applicant. I/we also indemnify the University against any claim whatsoever for
damages howsoever caused or arising which the Applicant may sustain whilst registered as a student at
the University, acknowledging that the Applicant’s participation in any sporting or other activity at the
University or conveyance of the Applicant in any University vehicle, shall be at the Applicant’s sole and
absolute risk. This indemnity shall be binding on the Applicant’s Executors and Heirs:

That I/We acknowledge that a Minimum Initial Payment (MIP) is required by mid-January each year,
including the first year of study, unless satisfactory arrangements have been made with the University.
Details of the MIP amount will be included in future correspondence with the applicant:

That a statement signed by the Registrar (Finance) shall represent the amount owing to the University
by me/us, and further that in the event of such amount being handed over for collection I/we shall pay
all legal charges incurred on the attorney and client scale:

That I/We will pay interest on all overdue fees, and disbursements at the rate of 2% per month compounded
monthly and calculated from the first day of each month following the date by which final payment of
all fees and disbursements must have been made:

That I/We shall abide by all regulations of the University – and further that the applicant shall, if
accepted, be under the disciplinary control of the University as from the date on which he/she takes
up residence at the University or the day on which he/she commences studies or attends an orientation
week or summer school or similar function or registers as a student, whichever is earliest, until the
University accepts a notice of withdrawal from me/us or the applicant fails to renew his/her registration
on the due date, whichever is the later:

That I/we accept and understand that the University keeps documents, including this Declaration and
Agreement, electronically and distributes them as such. The University shall at all times be entitled
to utilise such documents in electronic format for whatever purpose required and I/We agree that the
electronically generated documents shall replace the originals signed by me:

That although the University does not take any responsibility for informing parents or guardian or
major fee contributor of disciplinary action against a student (whether pending of finalized), academic
performance or any other matters relating to the student, the University may in its discretion report
to the parents or guardian or major fee constributor such breaches of the rules by the applicant as
the University deems necessary and further to report on any matter concerning progress, conduct,
well-being or health of the applicant, and further that the University may take all such steps as it
considers reasonable in the event of the applicant becoming ill or requiring medical attention without
the University undertaking any legal obligation to do so.

Signature of applicant: ________________________________________________________________

Signature of person responsible for fees (if not applicant: __________________________________
Date: _______________________________________________________________________________