APPLICATION FOR ADMISSION

MBA / MPA PGDM

POST GRADUATE PROGRAMMES

Year of Application for admission to the University:



PLEASE INDICATE THE PREFERRED PROGRAMME OF STUDY:

Master of Business Administration  
Masters of Public Administration  
Postgraduate Diploma in Management  

APPLICATION FEE:

Every completed application form must be accompanied by a non-refundable
application fee of R100.00 or late application fee of R150.00 payable in the form of a postal order

 

Please indicate your three (3) preferred areas of specialization in order of importance:

1.
 
2.
 
3.
 

Completed forms should be sent to:

 

The Programme Director-Postgraduate Programmes

Graduate School of Business & Government Leadership

University of North-West

Faculty of Commerce and Administration

Private Bag X2046

Mmabatho, 2735

Tel: (018) 389-2183 / 389 2215 Fax (018) 392-1898 / 389-2090 / 392-5753

Website: http://www.uniwest.ac.za or http://unw-gradshool.org.za

FOR OFFICE USE ONLY

Receipt No:



Received
Application Approved

Write only one letter in the vertical, always starting in the first box. To exercise any option, write an X in the appropriate box

Surname:  Initials: 

First Names: 

Have you been registered at this University: YES NO

If so, please state Student Number: 

First year of Registration:  Identity Number: 

Date of Birth:  Maiden Surname: 

                    (DDMMYYYY)

Title: Marital Status:

Population Group:

Religion (Specify)

10

Mr

 

19

Miss

 

31

Mrs

 

85

Mz

 

13

Dr.

 

24

Rev.

 
 

Other: (Specify)

 
 

1

Unmarried

2

Married

 

Other: (Specify)

 

7

Asian

34

Coloured

19

North Sotho

18

South Sotho

22

Tsonga

23

Tswana

42

White

20

Xhosa

21

Zulu

 

Other: (Specify)

 
 
Citizenship:

100

South African

 

Foreign

(Specify)

 
 
Type of Permit:

1

Study Permit

 

2

Residence Permit

 

3

Other: (Specify)

 
 

Gender:

Home Language:

Permit Number:

M

Male

 

F

Female

 

12

English

69

Setswana

 

Sesotho

 

North Sotho

 

Other: (Specify)

 
 
               
Permit expiry date:
               
(DDMMYYYY)

B. CONTACT PARTICULARS

Tel:(W)  Tel:(H) 

Cell:  Fax: 

Residential Address:



City:  Code: 

Postal Address:



City:  Code: 

Forwarding Address:



City:  Code: 

C. MEDICAL CONSIDERATIONS

Type of disability / chronic illness (e.g. Wheelchair user – paraplegic)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Details of your needs (e.g. Access to and inside buildings, parking)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________ 

____________________________________________________________________________________

D. FINANCIAL CONSIDERATIONS

Have you discussed your attendance of the programme with your organisation? Yes U No P

f YES, is your organisation willing to sponser? Yes U No P

Method of Payment

 

Self

 

Loan

 

Sponsor / Bursary

 

 

If Payment by Sponsor / Bursary
complete the following section:

Sponsor Extent:

Full

 

Partial

 

 

 

Payment Basis:

Advance

 

On Results

 

 

Sponsor’s Details:

Sponsor’s Name: 

Contact Person’s Name: 

Telephone:  Fax: 

E-mail: 

Sponsors Address:



City:  Code: 

E. QUALIFICATIONS (POST MATRIC) 

Period
Name of University / Technicon / College, etc
Name of Degree / Dipl. / Cert.

From

YY MM

To

YY MM

Study Completed (Yes/No)
Student Number
           
           
           
           
           

F. EMPLOYMENT HISTORY (NB. CURRENT AND TWO PREVIOUS EMPLOYMENT)

Organisation Name: 

Title: 

Period: From:  To: 

                        (DDMMYYYY)      (DDMMYYYY)

Key Duties: ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Organisation Name: 

Title: 

Period: From:  To: 

(DDMMYYYY) (DDMMYYYY)

Key Duties: ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Organisation Name: 

Title: 

Period: From:  To: 

                        (DDMMYYYY)              (DDMMYYYY)

Key Duties: ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_______________________________________________________________________

G. PROFESSIONAL REFERENCES

First Referee:

Name: 

Position in the Organisation: 

Name of Organisation: 

Postal Address:



City:  Code: 

Telephone:  Fax: 

Second Referee:

Name: 

Position in the Organisation: 

Name of Organisation: 

Postal Address:



City:  Code: 

Telephone:  Fax: 

How did you learn about the MBA / MPA /PGDM Programme?

Word of mouth via an MBA / MPA / PGDM student / graduate  
Newspaper advertisement (please specify which)  
Other (please specify)  

H. DECLARATION

I, ________________________________________________ hereby certify that the information given is accurate and complete, and undertake to pay all the fees to the University as and when they fall due for payment, and abide by all the rules and regulations of the University, as well as the Postgraduate Programmes of the Graduate School of Business and Government Leadership.

 

Signature: _________________________ Date: _________________________

Witness: _________________________ Contact No: ____________________

Signature: _________________________ Date: _________________________

CHECK LIST (FOR OFFICE USE ONLY)

 
Items
Yes/No
1
Application for admission Post-Graduate Programmes (Graduate School)  
2
Detailed Curriculum Vitae  
3
Certified copies of all certificates  
4
Certified copies of all academic records / transcripts  
5
Certified copy of I.D. / Passport (first page with your picture on it)  
6
Two passport sized photos  
7
Receipt / Postal order of R100.00 application fee or R150.00 in case of late application