See instructions and codes in the CAO Handbook. Do NOT use a copy of this form.

Each one contains a unique CAO number. The CAO will only accept one application from you for entry in a specific entry year and term.

Write clearly! Mark boxes with 4

900174884105

YOUR CONTACT DETAILS

First names Title
ID or passport number

Surnames Date of birth

ADDRESS FOR POSTAL DELIVERIES

Postcode

Country (if not South Africa)

until

/indefinitely

ALTERNATIVE OR NEW POSTAL ADDRESS (for CAO to use if letters are returned)

Postcode
NEXT OF KIN: Title Initials

Country (if not South Africa)

Surname Relationship

until

/indefinitely

Postcode
EMAIL: Attention FAX: Attention

Country (if not South Africa)

address code number @ number Cellphone

until
Use until Use until

/indefinitely /indefinitely /indefinitely

PHONE: Home code Day/Work code Next of Kin: Home code Work code Cellphone Number number

(for SMS messages)

number

If we cant contact you, with whom can we leave a message? Name code number

ABOUT YOURSELF
CONFIDENTIALITY:
Do you wish your information sent only to the institutions to which you have applied?

PREVIOUS SURNAME (if applicable) ARE YOU A SOUTH AFRICAN? Yes To be completed by International applicants only COUNTRY OF CITIZENSHIP What sort of South African permit/visa do you have? None/Not yet issued Work Study Refugee status Permanent resident

Yes No

I authorise you to release my details to other institutions.

Asylum seeker
Please attach photocopy.

FINANCIAL AID Applications must be made on each institutions own financial aid form.

Tick this box if your familys gross annual income is less than R150 000 and you intend applying for financial assistance.

PLEASE PROVIDE THE FOLLOWING FOR STATISTICAL PURPOSES

Male Female African Coloured English Indian White Other seSotho Single/not married sePedi siSwati Married HOME LANGUAGE Afrikaans isiNdebele

xiTsonga seTswana tshiVenda isiXhosa isiZulu Other Which of the following best describes what you have been doing so far this year? Grade 12 learner at high school Upgrading Senior Certificate Working Unemployed Degree student Diploma student FET College student College of Nursing student Private College student Student at a foreign tertiary institution Other (give details)

If you are faxing this form write your CAO number here and on every page in the top right hand box provided

CENTRAL APPLICATIONS OFFICE

CAO number if faxing

www.cao.ac.za enqgeneralcao@cao.ac.za Fax: +27 31 268 4422 Share Call: 086 086 0 CAO/226 International: +27 31 268 4444

Attach your documents inside the form APPLICANTS WITH DISABILITIES

Epilepsy

CAO number if faxing

Higher education institutions are sensitive to your needs. Please indicate if you have any conditions requiring assistance. Blind Partially sighted Deaf Partially deaf Wheelchair Crutches/callipers Paraplegia Ailments requiring support Other (give details) Cerebral palsy Psychological or learning difficulty

HIGH SCHOOLS ATTENDED

School name From To

School name

From

To

School name

From

To

SCHOOL LEAVING EXAMINATION RESULTS

National Senior Certificate N3/4 HIGCSE GCE Senior Certificate (prior to 2008) IB Other

Year of exam National Certificate (Vocational)

Examining authority e.g. KZN, Eastern Cape, IEB Examination number Send us copies of all available examination results and any exemption. If you are writing this year enter the subjects (and grades/ Level/ Level/ Grade/ levels where application) to be written. Grade/ Level (e.g. Symbol Level (e.g. Symbol Subject Subject achieved % HG, O) achieved % HG, O)

Complete the following section if you wrote the old Senior Certificate Type of exemption: Full Ordinary Conditional Mature Age Immigrant Foreign None/Not yet awarded Enter the mark range shown on your Senior Certificate (e.g. 950-1199) Aggregate as shown on Senior Certificate

OTHER POST-SCHOOL EXAMINATION RESULTS

Year of exam Subject
Level/ Grade/ Level (e.g. Symbol achieved % HG, O)

Exam Subject

upgrading
Level/ Grade/ Level (e.g. Symbol achieved HG, O) %

SCHOOL EXAMINATION RESULTS (if you are still at school)

Send us additional results as they become available. My position in Grade 11 was out of a total of Final exams Grade 11
Level achieved Mark out of

learners in the whole of Grade 11. June exams Grade 12 Trials/Mocks Year of exam Year of exam
Mark out of % Level achieved Mark Mark out of % % Level achieved

Year of exam Subject

Mark

Mark

ARE YOU STUDYING NOW OR HAVE YOU EVER STUDIED?

Date from To Institution Campus Qualification name Student number

CAO number if faxing

Qualif. complete

Awaiting result

Yes Yes Yes

No No No

Yes Yes Yes

No No No

Have you previously studied? If you are applying to that institution only contact them before applying through the CAO. Do you intend applying for exemptions/credits? Yes No Have you ever been excluded from a tertiary institution or a residence? Yes No If yes, year of exclusion Institution Details

LIST YOUR PROGRAMME CHOICES HERE IN ORDER OF PREFERENCE

If you have already applied for the same entry year and term, do NOT apply again but send us your final list of choices. Select your programme choices and institutions from the list in the CAO Handbook or on the website www.cao.ac.za Entry Do you need Year of Entry Programme name Programme code level residence? entry Choice e.g. ZU-R-PR3 Yes No e.g. 2013 term e.g. 1st yr e.g. N Dip Public Relations Management 1st 2nd 3rd 4th 5th 6th

Institution campus programme

Some programmes may consider only 1st or 2nd choices

Check the closing dates of the programmes you have chosen and get the form and fee to us in time. Late applications may not be considered.

DECLARATION BY THE APPLICANT

I, (name and surname) the undersigned applicant, being over 18/assisted by my parent or legal guardian as I am under 18, declare that all the information supplied is true to the best of my knowledge and that none of the information requested has been withheld. I have read and I understand the terms and conditions in the CAO Handbook and/or on the CAO website. I understand that this application cannot be processed until the application fee has been paid. I agree that the CAO should proceed with processing my application even if it is too late for some or all of the programmes I have selected. I understand that the application fee is not refundable. I understand that institutions apply selection procedures and that offers of places may be withdrawn if the conditions are not met or if institutions discover that I have provided false information in my application for admission. I undertake to submit to the CAO any documentation not included with this form and copies of outstanding examination results when requested to do so, and to inform the CAO of any change of contact information. Date Signature of applicant Signature of parent or legal guardian
Mother Father Guardian

(where the applicants National Senior Certificate results are not yet available) I, the undersigned, confirm that the school record and examination results provided with this application and, to the best of my knowledge, the other information provided in this form are correct. Date Signature

DECLARATION BY OR ON BEHALF OF THE SCHOOL PRINCIPAL

School stamp

KEEP THIS SECTION AS YOUR RECORD OF YOUR APPLICATION BANKING DETAILS ON THE BACK I sent my form by Method of payment Postal order Type of credit card post EasyPay email fax by hand credit card Date: ............................................. cheque

direct deposit

money order Visa Mastercard Amount paid ..................... Authorised by .......................................

HAVE YOU INCLUDED?

Certified copy of your identity document or passport Certified copy of school leaving exam results or certificate (if already issued) Copy of school examination results certified by school principal (if still at school)

CAO number if faxing

Copy of academic record and certificate of good conduct (if you have already studied at a tertiary institution) Copy of Study or Residence Permit (if you are an international applicant) Programme codes of the programmes for which you are applying Please do NOT send us your original documents. We cannot be held responsible for your documents safe keeping. If a portfolio is required, send it directly to the institution and NOT to the CAO.

APPLICATION FEE To start studying in: If form and fee reach us by: Pay: From the above dates until: Pay: July 2012 31 May 2012 R160 31 July 2012 R300

SA Residents January 2013 31 October 2012 R175 31 January 2013 R300 July 2013 31 May 2013 R175 31 July 2013 R300

International Apps All entry terms Same dates R250 Same dates R500

If using this form to apply for entry in 2014 or later, please contact us to confirm the fee.

CHOOSE YOUR METHOD OF PAYMENT: The CAO does not accept cash payments
direct deposit credit card *cheque *postal order *money order You can now pay your application fee at Checkers, Pick n Pay or any outlet with the EasyPay sign. * Make payable to the Central Applications Office and write your CAO number on the back. International applicants should ensure that the amount paid covers bank charges. If we do not receive payment, we shall send your form back to you. If your payment is not honoured, bank and administration charges will be passed on to you. Payment by credit card Type of card Visa Mastercard (regret other cards not acceptable) Card holders name................................................................. Credit card number Card holders identity number............................................ Card holders daytime contact number.............................. When does your card expire?
CAO OFFICE STAMP Init
Scanned Pmt check No pmt SMS Pmt resolved Barcode/Rescan Dup check Initial capture No choice/ Int transfer SMS Full capture Checked

FOR OFFICE USE ONLY

Date

Card validation number (last 3 digits on back of card) Please debit my credit card the sum of R................................// the value of US$................................ in South African Rand (see over for charges) Card holders signature.............................................................. Central Applications Office, Private Bag X06, Dalbridge, 4014
email: formsreceivedcao@cao.ac.za fax: 0866 22 8818 (dial +27 31 268 4422 from outside South Africa)

Post, email or fax this form to:

CAO Number 900174884105

Account name: Central Applications Office

>>>>>> 962509001748841057

Account no: 4071690537 Branch code: 632005 Reference no: Your CAO number