Registration Info SECTION A: ADMINISTRATIVE INFORMATION Have previously enrolled at Jeppe Education Centre? —Please choose an option—YesNo If Yes, Please enter student Number Enter Date registered First Name Last Name When did you finish Matric? 2022202120202019201820172016201520142013 or Below Highest Grade Passed How Many subjects do you wish to rewrite or Upgrade? (NB: maximum number of subjects to rewrite or upgrade is 6*) Which branch do you wish to attend from? —Please choose an option—Johannesburg CampusPretoria CampusPolokwane CampusBloemfontein CampusVereegining Campus SECTION B: LEARNER'S DETAILS Enter Date of Birth Gender —Please choose an option—MaleFemaleOther Nationality Home Language Enter Your Email address Do you have a disabilty? —Please choose an option—YesNo If yes, describe nature of disability What do you use ? —Please choose an option—SA ID NumberBirth certificatePassport Phone Number Physical Address [cf7mls_step cf7mls_step-1 "Next" ""]SECTION C: PARENT'S/GUARDIAN'S DETAILS Title Full Names Marital Status MarriedSingleWidowed ID Number/Passport Occupation Employer Work Tel Cell Number Email Address Residential Address I understand that this form collects my data so I can be contacted. For more information, please check our privacy policy [cf7mls_step cf7mls_step-2 "Next" "Step 3"] Previous Next
