NAMCOLNamibian College of Open Learning

APPLICATION FORM FOR TVET PROGRAMS 2016

LEARNER SUPPORT SERVICES Private Bag 15008, Katutura, Republic of Namibia

Telephone: +264 (61) 320 5111Fax: 264 (61) 216 987

Automotive Mechanics

Plumbing and Pipefitting

Welding and Metal Fabrication

Student No:

Title:

Surname :

First Names:

Date of Birth :

ID Number:

Male Female

Do you have a disability? Yes No (information required for planning purposes only)

If “Yes” please specify: .......................................................................................................................

Postal Address: Street Address:

P.O. Box ..…………………….......……….......… Street ………………............................................…

Private Bag …………………………................... Erf No. ...........................................………………...

Name of Post Office …………………................ Village/Town/City …................................………….

Telephone Numbers:

At work: code: ………....... Tel: ……………..................... Fax: ……...….….......…...............

At home: code: ……....…... Tel: ………………................. Cell: ..........……….......……........

E-mail: .....................................................................................................................................

Name of Employer: ……….............................................................................…………………………

Position held: ……...........................................................................................................…………….

Guardian's Name: ..............................................................................................................................

Guardian's Contact Detail: .................................................................................................................

Tick (√) in the box next to the programme you would like to apply for:

NB. Only at Yetu Yama Centre, Katutura

(For office use only)

Y Y Y Y - M M - D D(year-month-day)

Yetu Yama Centre

Otjiwarongo Centre

Ongwediva Centre

Rundu Centre

Trade: OfficeAdministration:

MotherTongues:

AcademicQualification:Institution Certificateobtained Year

Experienceinrelatedfieldofwork:Position Institution Year (eg. 1990-2013) Responsibilities

Why do you want to enrol for this programme?

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……………………………………………………………………………………………………….....………

……………………………………………………………………………………………………….....………

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I understand that completion of this form does not necessarily mean automatic acceptance into the training programme requested. I agree to make myself available for the aptitude testing and interview. I further acknowledge that if accepted into a training programme, I will sign the Trainee’s Code of Conduct agreeing to abide by the Training Centre’s Rules and Regulations.

Applicant’s Signature: ………………………………………. Date: …...........…….........................…….

Signature of Guardian (if under the age of 18): ..................................................................................

NB!!Attachallcertifiedcopiesofqualifications,identificationdocuments,workexperience(e.g.testimonialletters)andyourpassportphoto.

Result Interview Result FinalCHECKLIST:

Reject / Accept for Aptitude Testing of Aptitute Test Date of Interview Decision

Initials of Evaluator: ....................... ............... ............... ................... ..............

Afrikaans

English

German

Ju!'hoansi

Khoekhoegowab

Oshikwanyama

Oshindonga

Ojtiherero

Rukwangali

Rumanyo

Setswana

Silozi

Timbukushu

Other:....................................

Enclose a cheque or copy of receipt of N$50 for processing fees.

Include all required paper work

Completed application form