Residence Application

RESIDENCE APPLICATION FORM

Please read the instructions below before completing this application form

CAMPUS

Stellenbosch Pretoria

Year of Study

Applicant Details

Student Surname

Student Name

Student ID Number

Student Mobile number

Student e-mail address

Name & Town of last school attended

Institution for study

Field of study (course)

Home Language

Race

Medical Aid Company

Medical Aid Plan and Number

Where have you heard of the residence?

Mother / Parent 1 / Guardian

Name & Surname

ID number

Residential Address

Postal Address

Tel. Home

Tel. Work

Mobile Number

E-mail address

Occupation

Father / Parent 2 / Guardian

Name & Surname

ID number

Residential Address

Postal Address

Tel. Home

Tel. Work

Mobile Number

E-mail address

Occupation