FOR OFFICE USE ONLY

APPLICATION FOR UNDERGRADUATE ADMISSION

Please read the relevant section in the Undergraduate Student Handbook BEFORE completing this
form.

Have you previously been registered at Rhodes University

Yes No
Please ü where relevant

If “YES”, please supply your student number

Please complete all sections below:

LAST NAME(SURNAME):
FIRST NAMES (in full):

MAIDEN NAME (if applicable):

TITLE (Mr, Ms): INITIALS:

POPULATION GROUP: HOME LANGUAGE:

(eg. Indian, African, Coloured, White) (eg. isiXhosa, English, seSotho, Afrikaans etc)

CITIZEN STATUS: NATIONALITY:

(SA Citizen, Foreign with SA permanent residence, or Foreign requiring a study permit)

DD MM YY

DATE OF BIRTH:

SA IDENTITY NUMBER OR PASSPORT NUMBER

Please indicate any physical disability (tick, where appropriate)

This information will not disadvantage your application

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 Physical (Moving/Standing/Grasping)
U Unspecified M More than one disability

Please give us some details of your disability

PROPOSED REGISTRATION

Please note that Rhodes University does NOT offer Engineering, Architecture, Veterinary Science,
Dentistry, Medicine or Actuarial Science.

Full-time/Part-time/Special:

CHOICES OF DEGREE/DIPLOMA (eg. BA, Social Sciences, BSc, BCom, Pharmacy, Business Sciences):

First degree choice:

Possible subject choices (eg. Journalism, Chemistry, Economics, Zoology, Politics):

Second degree choice:

Possible subject choices (eg. Journalism, Chemistry, Economics, Zoology, Politics):

PREVIOUS STUDIES
Have you previously been enrolled at a university/higher education institution (other than Rhodes)?
Please ü where relevant
Yes No
If “YES”, please complete the following:
(Please provide a full transcript academic record & certificates of conduct from all institutions attended.
NB: A transcript is a document setting out your full academic record from the institution. The transcript
is different to a statement of results. Please ensure that you provide a full Academic Transcript - which
includes FINAL results).

YEAR INSTITUTION DEGREE/QUALIFICATION DEGREE COMPLETED? STUDENT NUMBER AT THAT

YES or NO INSTITUTION

Please give a short explanation of why you wish to transfer to Rhodes University

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

DIALING CODE: FAX NUMBER:

POSTAL CODE CELL:

PROVINCE: E-MAIL:

(NB: We will email correspondence to this address)

HOME STREET ADDRESS:

POSTAL CODE

PROVINCE:

GUARDIAN OR PARENTS ADDRESS: DIALING CODE: TELEPHONE NUMBER:

DIALING CODE: FAX NUMBER:

POSTAL CODE
CELL:

PROVINCE: E-MAIL:

FEE PAYER DETAILS

Yes No
Will you be paying your own fees

If NO Please provide following fee payer information :

Title: Last name: Initials :

ID / PASSPORT NUMBER

TO BE COMPLETED BY PRESENT LEARNERS TO BE COMPLETED BY APPLICANTS WHO ARE NOT

CURRENTLY AT SCHOOL CURRENTLY ATTENDING SCHOOL

Final school year: 20 Please provide details of your activities since leaving

Number of years spent at this school: school (eg working, studying ):

Examining Board:

Examination number: (if known)

Name of your School:

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 VERY IMPORTANT!!
EXAMINATION RESULTS

PLEASE ONLY COMPLETE THE SECTION RELEVANT TO YOUR SCHOOLING.

Please DO NOT use correction fluid on examination results.

Please attach a certified copy of your school certificate to this application.

If you have not yet completed your schooling please attach a copy of the latest results of your most
recent examinations.

SOUTH AFRICAN NATIONAL SENIOR CERTIFICATE APPLICANTS (Any learner completing grade 12) –
please complete this section only

Which results are you providing? Grade 11 Grade 12

Final Exam Results

Subject % Subject %
eg. English 1st Language 59% eg. Life Orientation 49%
1. 5.
2. 6.
3. 7.
4. 8.

FOREIGN QUALIFICATION APPLICANTS – please complete this section only

Students doing A-levels/AS levels should enter their mock A-level/AS levels results and supply a
certified copy of their O-Level results.

Students doing HIGSCE or IB examinations should enter their mock results and where relevant supply
certified copies of their IGSCE results.

Subject Grade/ Symbol Subject Grade Symbol

Level /Level
eg. English 1st Language AS-level D eg. Accounting A-level C
1. 5.
2. 6.
3. 7.
4. 8.

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FINANCIAL AID (FOR SOUTH AFRICAN STUDENTS ONLY)

Please provide the following information for the University to adequately ascribe you to the correct
income bracket for student fee purposes.
Family’s Gross Annual Income (e.g. Father and Mother’s / Guardian’s total income for the whole year
before deductions) R

Please indicate if you will be applying for NSFAS funding?

Yes
No

PLEASE NOTE THAT YOU ARE STILL REQUIRED TO APPLY DIRECTLY TO NSFAS via the website
www.nsfas.org.za.

RESIDENCE APPLICATION

Please note that residence allocations are carefully managed and that we cannot guarantee allocations
to a single room or to a specific residence.

DO YOU REQUIRE RESIDENCE ACCOMMODATION? Yes No

Please ü where relevant

GIVE US SOME ADDITIONAL INFORMATION ABOUT YOURSELF

Take time to fill in this section. This form is seen by the Dean when your application is considered and
your answers here can make a difference.

SECTION 1: YOUR SCHOOL HISTORY

Give details of school prizes, leadership positions you have held ( e.g. SRC)

What community involvement have you had (e.g. charitable, religious, youth organisations
etc.)

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 Please specify your non-academic interests (e.g. art, music, hobbies etc.)

Besides the prescribed books what other books have you read and share with us the reasons
for the ones that interest you the most?

2. Please list the adults you live with and give their occupation and highest educational qualification:

RELATIONSHIP TO YOU OCCUPATION HIGHEST EDUCATION

eg. Father eg. Teacher eg. Bachelor’s Degree

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SECTION 3: YOUR RHODES UNIVERSITY FUTURE

 Studying at Rhodes University will have a huge influence on your future!

Please answer the following questions:

1. Why do you want to study at Rhodes University and why these specific degree choices ?

2. What do you anticipate might be the particular challenges you will face in studying at
University?

3. What do you hope to do after you have completed your degree?

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 NB: DO NOT FORGET TO SIGN THIS DECLARATION
DECLARATION AND AGREEMENT
I declare that:

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

I accept liability for any damage to University property caused by me and I indemnify the University against any loss of or damage
caused to my property kept at or left at the University. I also indemnify the University against any claim for damages which I have
while I am registered as a student at the University, especially acknowledging that my participation in any sporting or other activity
at the University or my travelling in any University vehicle, shall be at my sole and absolute risk. This indemnity shall be binding on
my Executors and Heirs:

I undertake to pay all amounts due to the University and acknowledge that a Registration Fee is required by a set date each year,
including the first year of study, unless satisfactory arrangements have been made with the University. I will pay interest on all overdue
fees and other charges at rate published in the annual fees booklet and on the website, calculated from the first day of each month
following the date by which final payment of all fees and charges must have been made. I will be liable for all costs of recovery of
amounts due by me including legal charges incurred on the attorney and client scale.

I agree to be bound by and comply with all regulations of the University and understand that if I am accepted I shall be under the
disciplinary control of the University as from the date on which I move into residence at the University or the day on which I begin
studies or attend an orientation week or summer school or similar function or register as a student, whichever is earliest, until the
University accepts a notice of withdrawal from me or until I fail to renew my registration on the due date, whichever is the later.

I accept and understand that the University keeps documents, including this Declaration and Agreement, electronically and distributes
them electronically. I agree that the University may use these documents in electronic format for whatever purpose required and I
agree that the electronically generated documents shall replace the originals signed by me.

I agree that the University may, without contacting me, report to my parent or guardian or major fee contributor any disciplinary
offences I may commit. I also agree that it may also report on any matter concerning my progress, conduct, well-being or health and
that the University may take whatever steps as it considers reasonable should I become ill or require medical attention. I understand,
however, that the University does not take any responsibility or legal obligation to report these matters.

Signature of applicant: ........................................................................

Date: .......................................................

CHECK LIST
BANKING DETAILS FOR
A. Have you enclosed with your application form?
RHODES UNIVERSITY
Proof of Direct Deposit of application fee of R100.
DO NOT ENCLOSE CASH
FNB Bank Grahamstown
Account Name:
Certified copy of your latest exam results/matriculation certificate (post-matriculants only),
Rhodes University
O/AS/A-level
Account Number:
certificate or IGSCE/HIGSCE results.
62145504553
Branch Code:
210-717
B. Has your form been signed?
Swift Code:
FIRNZAJJ
REFERENCE:
CLOSING DATE: RETURN THIS FORM TO:
SURNAME & INITIAL
30 SEPTEMBER STUDENT BUREAU (in that order)
Late applications from South RHODES UNIVERSITY
PO BOX 94
African students may be accepted Attach a copy of the Deposit
GRAHAMSTOWN 6140
at the discretion of the Registrar Slip to this Application
Form.