StellenboschUniversity

School of Public Leadership

Application for Postgraduate Diploma in

EnvironmentalManagement

1.Surname:______

2.Name(s)______

3.Postal address: ______

______

Code______

4.Residential address: ______

______

Code ______

6.Work address: ______

______

Code ______

7.Tel: (h): ______

8.Cell:______

9.Tel: (w):______

10.Fax :______

11.Date of birth: ______

12.ID number:______

13.Marital status: ______

14. Nationality: ______

15. Home language: ______

16.Year of Grade 12 / Matric completion: ______

17.E-mail address (compulsory): ______

18.Do you have access to the Internet ______

19.Have you previously applied for admission to the School of Public Leadership (Previously School of Management and Planning?)

If “Yes”, in which year? ______

20.Provide information regarding your academic and/or professional qualifications.

Institution / Qualification / Major Subjects / Year Achieved

21.Provide information regarding incomplete studies (See example attached for current students)

Institution / Year Commenced / Detail of Studies / Full-/Part-time
Current students
Stellenbosch University / 201???? / Currently Studying / Full time

22.Provide the following information regarding the past five years.

Employer / Position(s) Held / Period

23.Provide the telephone number of your present employer: ______

24.Is your employer assisting you financially? ______

25.Supply the names of two referees who will be able to provide the School of Public Management and Planning with information regarding your training and experience.

Name / Position / Company Name and Address / Telephone No

26.How did you become aware of the Environmental Management Programme courses offered by this University?

Advertisement in mediaName of publication: ______

Present studentPast studentName: ______

OtherDetails: ______

27.Describe the organisational unit in which you are presently employed and relate it to the total organisation in terms of scope, size and responsibility. Please enclose a summary of your job description.

28.What are your expectations of the programme?

ORIENTATION AND BLOCK SESSIONS
(both are compulsory for all students)

Stellenbosch University Campus

ID PHOTO’S

Please attach a scanned photo

I certify that, to my knowledge, the information which I have supplied is correct and complete.

______

Signature of ApplicantDate

STRUCTURED APPLICATION

Compulsory document for the department for selection purposes

Email these documents to

IMPORTANT!! IMPORTANT!! IMPORTANT!!

WRITE (1000 words) WHY YOU WANT TO DO THIS PROGRAMME

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