Registration Info Have previously enrolled at Jeppe Education Centre? Which grade are you applying for? Full Name Cell Number Email Submit 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 Highest Grade Passed Grade applying for? SECTION B: LEARNER'S DETAILS Enter Date of Birth Gender —Please choose an option—MaleFemaleOther Nationality Home Language Enter Your Email 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 Are you applying for grades 10, 11 or 12? YesNo Enter the subjects you wish to do [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 SECTION D: 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"]
