Please mark the training intervention for the learner registration with a cross (X)
Internship / Experiential Learner
(P1 or P2) / TVET Learner / TVET Lecturer Development / Bursary Application / ABET/AET
Section A: LEARNER DETAILS
(Mandatory for all the registrations)
Surname
Name
(as per RSA ID document) / Race
Date of Birth / Age
RSA Identity Number / Gender
Is the learner disabled? / Yes / No / Please specify the type of disability if "yes"
Residential Address / Postal Code
Postal Address / Postal Code
Municipality / Province
Home Tel. Number / Work Tel. Number
Cellular Number / Fax Number
E-mail Address
Qualifications
SECTION B: COMPANY DETAILS
· Mandatory for all learner/lecturer placements, experiential learning and internships or any of the other training interventions where work-integrated or workplace learning is applicable.
· Learners who are employed also need to complete this section, e.g. ABET/AET learners
Company Name
Physical Address / Municipality
Province
Postal Address / Postal Code
Name of contact person
Telephone Number / Fax Number
E-mail Address / Cellular No.
merSETA Chamber
SDL Number / Company Size
SECTION C: TRAINING PROVIDER/INSTITUTIONAL DETAILS
· This section is mandatory for all the registrations.
Name of Provider / Public
Provider / Private Provider
Provider Registration/ Accreditation/SDL Number
Physical Address / Postal Code
Telephone Number / Fax Number
E-mail Address / Cellular Number
Training Site Address / Municipality
Province
Postal Code
SECTION D: DETAILS ABOUT THE TRAINING INTERVENTION
· This section is mandatory for all registrations.
Brief description of the training intervention
Learner Registration Date / DDMM20YY
Training Intervention Start Date / DDMM20YY
Briefly describe the duration of the training intervention
Learner Signature / Date / DDMM20YY
Training Provider Signature / Date / DDMM20YY
Company Signature / Date / DDMM20YY
The following documents must be attached to the registration form.
Please mark with a cross (X) whether the documents are attached.
1. A certified copy of the RSA identity document / Yes / No
2. Copies of qualification certificates / Yes / No
3. Bursary registrations only:
· An acceptance letter from the training institution (TVET, UoT, University);
· A duly signed bursary agreement between the learner and the SETA or its contracted agent, and Proof of registration from the institution. / Yes / No / N/A
4. Internships and experiential work experience only:
· A duly signed internship/experiential agreement, and
· A duly signed employment contract between the intern /experiential learner and the company (employer). / Yes / No / N/A
Approved by merSETA (Name) / merSETA Designation
Signature / Date / DDMM20YY
The merSETA Date Stamp
Document Title / Learner Registration Form: Internship, Experiential Learner, TVET Learner, TVET Lecturer Development, Bursary Application and ABET/AET
Document Number / CSD-FM-003 / Date Complied: / 01 November 2008
Page Number / Page 3 of 3 / *Last Revision Date: / 01 June 2015
Revision Number / Rev 02 / Access: / Controlled
23 May 2016 *The document with the latest revision date is the current official document