Enrolment Form

Enrolment Form

Student Number

UniCollege (Pty) Ltd (reg no 2012/119907/07)

Tel: (011) 955 5326 Fax: 0866 88 3861 Email:

Type of Qualification
Course name
Start date
Student details
Title / Full names
Surname / Preferred name
Nationality / Identity number
Postal address / Home address
Code: / Code:
Tel (home) / Tel (work)
Cellphone / Email

Your next of kin

Name / Relation
Tel (home/work) / Cellphone

Sponsor details

Sponsor name / Sponsor ID
Postal address / Home address
Code: / Code:
Tel (home) / Tel (work)
Cellphone / Email

Company details (if company paying)

Company name / Tel (company)
Company contact / Position
Postal address / Email
Code: / Cellphone

Payment details

Tuition fee (cash/terms) / Initial ……….. / Deposit for tuition
Registration fee / Initial ……….. / Instalments / R……………… x ……… months Initial ………..
Other …………………. / Initial ……….. / Receipt no(s)
Total contract fee / Initial ………..

Agreement and Signature

I, ………………………………………………………………………………………………………..…………… (student or parent/guardian if student under 18),

and I/we ……………………………………………….…………………………………………………...……..…………… (sponsor/company) hereby agree to be liable / jointly and severally liable for the contract fee, subject to the enrolment terms and conditions attached. I/we further agree that failure to attend lectures will not reduce my liability under this contract.

Signature student ______Date ______

Signature sponsor/company ______Date ______

Please list modules that you are enrolling for (only if you are not enrolling for the full programme)

For government statistical purposes, we require the following student information. Please assist us by completing below.

Demographic Information

Student Age
(as at 31 Dec) / Student Gender / Student Ethnicity
Occupation / Nationality
Gender / Ethnic Group
Marital Status / Home Language
Where did you hear about us? (please circle all relevant) / Word of mouth / Facebook / School visit / Advertising / Where?
Internet Search / Other, please specify

Secondary Education

High School attended
Highest grade passed / Year

Tertiary Education

Please list any tertiary qualifications

Disabilities

Please list any disabilities that we should be aware of

Language Skills

ENGLISH / Excellent / Average / Poor / General Comments
Reading
Writing
Speaking

Medical Conditions (State any medical conditions that we should be aware of and who should be contacted in an emergency)

Emergency Contact: / Telephone Number:

Special Learning Needs (State relevant disabilities or learning difficulties)

What is your motivation and reason for entering this programme?

What are your expectations / what are the outcomes you would like to achieve from this programme?

Enrolment Terms and Conditions

Contract entered into by and between UniCollege (Pty) Ltd (reg no 2012/119907/07) (hereinafter “UniCollege”) and

…………………………………………………………………………………………………………………………………….……………………… (hereinafter “the Student”) and

…………………………………………………………………………………………………………………………………………………….…………… (hereinafter “the Sponsor”).

1. General

1.1 Please read the terms and conditions carefully. The contents of this document, the student Code of Conduct, cancellation, deferral and re-do policies all constitute the Contract of Enrolment between UniCollege and the Student, his/her parent(s) and sponsor.

1.2  UniCollege reserves the right to create and apply rules (including due performance requirements) and the Student hereby agrees to be bound by such rules. UniCollege further reserves the right to combine classes of a similar academic level and content.

1.3  The Student is responsible for ensuring that he/she has been properly registered with any relevant external institute or examining body, where applicable, and that he/she has been registered for examinations with such institute or body.

1.4  The student by his/her signature hereto hereby confirms that he/she is fully aware of the type of course and/or programme enrolled for and that it is his/her responsibility to make himself/herself aware of the types of courses and that he/she has fully understood the type of course that he/she has registered for and that no representations have been made other than those contained in the official fact sheet. The student/sponsor hereby indemnifies UniCollege (Pty) Ltd against any claim they may have with regards to the type of course they have enrolled for. The student is further aware of the factsheet in respect of the programme/course enrolled for and confirms that it accurately reflects the qualification to be conferred and the type of programme/course registered for.

1.5  UniCollege reserves the right to withhold results and access to classes until outstanding amounts are

settled in full. UniCollege reserves the right to withhold certificates until the account has been settled in full.

1.6  The registration fee paid in terms hereof is non-refundable.

1.7  There will be a 30 day indulgence period for arrears, after which interest, at the prime overdraft rate of UniCollege’s bankers, may be charged.

1.8  The student and sponsor choose their home addresses for the purposes of service of any legal notices and processes, should legal action flow from this agreement. UniCollege chooses 17 Clew Street, Monument, Krugersdorp for the purposes of service of any legal notices and processes arising here from.

1.9  The Student and Sponsor undertake to pay legal collection costs including but not limited to attorney fees based on attorney/own client scale, collection charges and tracing fees, should UniCollege institute action for recovery of any arrears amounts.

1.10 Neither UniCollege nor any official employee or representative of UniCollege acting in his/her capacity as such shall be liable for any damage arising out of: the death, bodily harm, loss of health or illness of any Student howsoever caused; and the loss or destruction of or damage to any property owned by or in the custody of any Student, howsoever caused.

1.11 In the case of instances beyond UniCollege’s control and acts of God, UniCollege reserves the right to cease lectures and close the college temporarily. While every effort will be made to resume lectures as soon as possible, no warranties are made in this regard and no refund in fees will be made.

1.12 No variation or consensual cancellation of this agreement will have any force or effect unless reduced to writing and signed by both parties.

1.13 The student shall not, by reason of his/her failure to attend lectures, be entitled to a reduction in fees, nor will it absolve the student/sponsor (where the sponsor is not the student) from full liability for the payment of the full fees and other charges.

1.14 The right to attend lectures and write exams is not transferable. Accordingly, the student shall attend all lectures in person and shall be the only person entitled to write examinations in respect of the subjects forming part of the UniCollege programme for which the student has enrolled.

1.15 The student/sponsor accepts that UniCollege shall have the right to vary the programme syllabus at any time, without prior notification and without furnishing reasons therefore. UniCollege shall further have the right to alter timetables and programme commencement dates at its own discretion, on written notice to the student/sponsor. The student/sponsor hereby acknowledges and accepts that UniCollege shall have the right at all times to vary the terms and conditions hereof.

1.16 The student accepts, as stipulated in the UniCollege Assessment Policy (which shall be deemed to form part of this agreement) that as part of the assessment of the programme, the student must fulfil certain academic requirements, which may include (but are not limited to) the completion and/or sign-off of a Portfolio of Evidence and/or Logbook or other forms of assessments. The student understands that submission of any academic work should be the intellectual work of the student. Should submission of any academic work not be that of the student, it will constitute fraud, which may result in the expulsion of the student.

1.17 UniCollege is entitled, without consent of or notice to the Student or Sponsor, to cede, assign, delegate, sell, transfer, pledge and/or hypothecate all or any of its rights and/or obligations under this agreement.

1.18 If any provision or clause of this document and/or the student code of conduct and/or cancellation, deferral and re-do policies is found to be unenforceable, then such provision shall be severed from the remaining provisions thereof which remaining provisions shall not be affected and which shall remain of full force and effect.

2. Cancellation

2.1  UniCollege reserves the right to cancel or postpone a course. Students will be informed in advance and all fees will be refunded.

2.2  Cancellations from Students are accepted, in writing, up to 7 days prior to course commencement date. The Student will be refunded any amount paid, less the registration fee, provided notice of cancellation has been received from the student in time.

2.3  Should a Student wish to cancel less than 7 days prior to course commencement, the Student and Sponsor will remain liable for 25% of the tuition fee and the full registration fee.

2.4  Once the course has commenced, no cancellations will be accepted and the Student and Sponsor are liable for the full fee.

3. Deferral and redo

3.1  A Student may only defer to a later occurrence of the same programme with the written permission of UniCollege. Students must inform UniCollege of their request in writing. A deferral charge of 25% of the current cost of the programme to be deferred as well as an administration fee of R500 will be levied against the student. No registration fees are payable. Permission will only be granted if the application is accompanied by a doctor’s note giving a medical reason why the student cannot complete the current programme or, if the student is company sponsored, by a letter from the company if work commitments do not allow the student to complete the programme. UniCollege reserves the right to refuse a deferral request if the reasons are not satisfactory. The deferral only applies to the very next occurrence of the same programme. Fees must be paid in the same time-frame as that pertaining to the first programme else the deferral is not valid.

3.2  A Student who wishes to redo a programme, as a result of failing a programme and/or module will qualify for a 25% discount and will need to pay for any course material that has changed. No registration fees are payable.

4. Additional costs related to supplementary assessments

4.1 Students are responsible for the costs of all supplementary, postponed and deferred examinations, tests and assignments.

5. Rules and Regulations

The student/sponsor by his/her signature hereto hereby agrees to abide by all the rules and regulations of UniCollege and acknowledges that he/she can be disciplined in terms thereof. The student/sponsor further acknowledges that right of admission to UniCollege is strictly reserved and UniCollege may at its own discretion refuse admittance to any student.

Declaration by Student and Sponsor

I, ………………………………………………………………………………………………………………………………..………………………………………………… as Student, and

……………………………………………………………………………………………………………………………………………………………………………..……………… as Sponsor

confirm that I/we have read and understood the terms, conditions and contents of this document, the student code of conduct, cancellation, deferral and re-do policies and the fact, nature and effect of all the clauses/provisions were understood by me/us as well as the fact that some of these clauses / provisions contain terms that may affect me/us now or in the future.

Signature Student ______Date ______

Signature Sponsor ______Date ______

Please ensure that the supporting documentation below is submitted with a fully completed and signed enrolment form:

·  Certified copy of student’s ID document

·  Certified copy of sponsor’s ID document (where sponsor is not the student)

·  Certified copy of entrance qualification requirement (where relevant)

UniCollege (Pty) Ltd

Registration number 2012/119907/07

BANK DEBIT ORDER INSTRUCTION

Name ______Telephone ______

Address ______

Student (if not the same as above) ______Course code ______

Debit amount R______Commencement date ______

Abbreviated name as registered with the bank: UNI EDUC

Dear Sirs/Madams

The details of my bank account are as follows:

ACCOUNT NAME ______

BANK ______

BRANCH/TOWN ______

BRANCH NO ______

ACCOUNT NO ______

TYPE OF A/C ______

(savings, cheque, transmission)

This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I hereby authorise you to issue and deliver payment instructions to the bank for collection against my abovementioned account at my abovementioned bank on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me by giving you notice in writing of no less than 20 ordinary working days and sent by email to .

The individual payment instructions so authorised to be issued must be issued and delivered as follows:
On the ______day ("payment day") of each and every month commencing on ______.
In the event that the payment day falls on a Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account;

I understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.