Learner Application Form

[LOGO]

Organisation Description, vision, values, mission

Days/Times of Tutoring

Expected commitment

Deadline for application

APPLICATION FORM

Please ensure that you complete this form in full.

Learner Information
Name: / Surname:
School: / 2014 grade:
Gender: / Date of Birth:
Do you have any disabilities? Yes ( ) No ( ) / Birth Certificate/ID No.
Cell number: / Other contact numbers (Friend, Uncle, Sister etc):
Address: / Email address:
I am a citizen of: South Africa ( ) Other ( )
If other, please specify: …………………………………………
N.B. IkamvaYouth welcomes all township school learners from all African countries. / Do any of your siblings volunteer at IkamvaYouth? Yes [ ] No [ ]
Do any of your siblings attend at IkamvaYouth?
Yes [ ] No [ ]
Are you involved in any other extra-curricular programmes? Yes ( ) No ( )
Please provide details: ………………………………………….
Please list the subjects that you take at school currently:
Parent/Guardian Information
Parent /guardian 1
Full name: ……………………………………………………………
Relationship to learner: ………………………………………
Contact Number: …………………………………………………
Occupation: ………………………………………………………… / Parent /guardian 2
Full name: ……………………………………………………………
Relationship to learner: ………………………………………
Contact Number: …………………………………………………
Occupation: …………………………………………………………
Travel Costs
Is the branch within walking distance of your house?
Yes [ ] No [ ]
If yes, how long does it take you to walk from the branch to your house? (Minutes) …………………
If no, how much does transport cost...... / Are your parents willing and able to cover transport costs 3 times per week during the term and every day during June holidays until you finish grade 12?
Yes [ ] No [ ]
I want to join IkamvaYouth because…
Checklist (Please ensure that you have submitted the following documents with your application) / Please Tick ()
Copy of your birth certificate / Identity Document
Copy of your most recent school report

LEARNER DECLARATION AND COMMITMENT FORM

IkamvaYouth only works for learners who're committed, hardworking and serious about their future. We do not look at academic results when considering applications, but are looking for young people who're willing to give what it takes to achieve excellence. That's why we’re asking you to complete and sign this declaration & commitment form.

I, ______(full names) hereby declare that I understand and commit to the following (please tick):

  1. I will be required to attend every session as follows:
  2. Homework sessions: twice a week between 3:00pm and 5:00pm
  3. Saturday sessions: Ever Saturday between 9:00am and 12:00 midday
  4. Winter School: Every day (Monday to Friday) for the first two (2) weeks of the June/July school holidays
  5. If I miss a session, I must/will excuse myself in advance if possible, and provide a letter explaining my absence.
  6. If I fail to attend 75% of the above-mentioned sessions, I will be kicked out of the programme.
  7. I will be required to present my school report every term as soon as it has been released by my school.

I further commit to:

  1. Communicating in English (as often as possible) at the branch
  2. Working exceptionally hard
  3. Working on my own and bringing specific questions and problems to the tutoring sessions
  4. Getting to know the other learners in IkamvaYouth
  5. Having FUN!!!

______

Signature of LearnerDate

______

Witness Date

1