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Funding
Part-Time Programme Registration and Enrolment
Step
1
of
4
25%
Please complete and all sections of this agreement and return it with a proof of payment.
Student Name
*
First
Middle
Last
Date of Birth
*
MM slash DD slash YYYY
ID or Passport Number
*
Citizenship
*
Residency Type
*
Permanent
Dual (SA plus other)
Student Email Address
*
Student Cell Number
Student Term Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Student Home Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Equity
*
Black
Coloured
Indian
White
Other
Home Language
*
Gender
Female
Male
Socio-economic Status
*
Employed
Unemployed, seeking work
Not working, not looking
Not working, disabled
Not working, none of the above
Scholar/Student (not working)
Home-maker (not working)
Pensioner/Retired (not working)
Not working - no wish to work
Other
Calendar year you are registering for:
*
Programme you are registering on:
*
Diploma in Fashion Design
Degree in Fashion Design
Advanced Diploma in Fashion
Part-Time Fashion Design Course
Section Break
Student Disability status profile (Medically certified). For each disability listed, select the difficulty level experienced. You will not be disadvantaged by disclosing any pre-existing disabilities. (CONFIDENTIAL)
Seeing
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Hearing
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Communicating
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Walking
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Remembering
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Self-Care
*
No Difficulty
Some Difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties
Former difficulty none now
Disclosure of pre-existing conditions (CONFIDENTIAL)
*
(Any learning disabilities, personal illnesses or health conditions known of and existed prior to registration.) You will not be disadvantaged by disclosing any pre-existing conditions. Please use space provided below.
I declare that: 1. All the information given by me on this form is complete and true. 2. I indemnify the Elizabeth Galloway Academy of Fashion Design against any claims because of my negligence or wilful acts or omissions. 3. Neither I, nor any other person, will hold the Elizabeth Galloway Academy of Fashion Design, or any person involved with Elizabeth Galloway Academy of Fashion Design activities, liable for any expenses or compensation arising from any accident, injury, illness or death during the course of these activities, because of my negligence or wilful acts. 4. I understand that to qualify for moderation my class attendance must be at least 80% for each module.
Signature of Student
*
Student undertaking. (Foreign student who is enrolling) 1. I undertake to comply with Act No. 130 of 1998: Refugee Act, 1998. 2. I undertake to comply with Act No. 19 of 2004: Immigration Amendment Act, 2004. 3. Each year before registration, I will present myself to the Paarl Home Affairs centre to have my study / asylum permit verified. 4. When the Elizabeth Galloway Academy of Fashion Design has received a report from Home Affairs that my study / asylum permit has been verified and I may reside in the country will I be legible to register. 5. I indemnify the Elizabeth Galloway Academy of Fashion Design against any claims because of my negligence or wilful acts or omissions. 6. I accept full responsibility for
Emergency Information
Name of Medical Aid
Medical Aid Number
Contact Person
Contact Number
Relationship to Student
Signature of Student
Section Break
Shuttle service: Please complete address and cell number to subscribe @ R 2 500 per term
Address
Street Address
Address Line 2
Phone
Section Break
Parent/ Guardian/ Bursar
(The person responsible for payment of the student’s fees) We undertake to treat your personal information in compliance with Act No. 4 of 2013: Protection of Personal Information Act, 2013.
First
Last
Relationship to Student
*
Date of Birth
*
MM slash DD slash YYYY
ID or Passport Number
*
Nationality
*
Equity
*
Black
Coloured
Indian
White
Other
Email
*
Phone
*
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Parent/Guardian/Bursar (The person responsible for payment of the student’s fees) I declare that: 1. All the information given by me on this form is complete and true. 2. I indemnify the Elizabeth Galloway Academy of Fashion Design against any claims because of my negligence or wilful acts or omissions. 3. I accept full responsibility for the payment of all the fees associated with the student’s study at Elizabeth Galloway Academy of Fashion Design. 4. I will be liable for payment regardless of whether I have received an invoice or not. 5. I understand that if payment of fees or costs incurred by the student are not be received by the due date, Elizabeth Galloway Academy of Fashion Design may charge interest on overdue payment at a rate of 15% per annum, compounded monthly, up to and including the final date when the full payment is received. 6. Where the student has already been registered for the academic year: I accept the condition that if I, or the student for whom I am paying, discontinues or changes course at any time I will be liable for a reasonable cancellation fee or reasonable reduction. The cancellation fee will be the full amount of the study fees up to the end of the current academic year (the year for which the student is registered) and I will be responsible and liable for the full payment of such fees, unless the student discontinues due to serious injury sustained or serious condition diagnosed after enrolment, which prevents the student from continuing with their year. The person responsible for payment of student fees is encouraged to disclose any pre-existing conditions before enrolment. This information gives personnel the necessary information firstly to advise a different course structure if considered necessary for student success and secondly to be able to treat the student appropriately, especially in case of an emergency. Elizabeth Galloway Academy of Fashion Design has decided on this cancelation fee with regards to discontinuing students, taking into regard the following factors as stipulated by the Consumer Protection Act: • The nature of the service that was reserved, is private higher education that is highly specialised; • Elizabeth Galloway Academy of Fashion Design will have no reasonable potential, acting diligently, to find an alternative student for the remainder of the academic year due to the specialised service being provided; • The general practise of private higher education institutions is to keep students liable for their full study fees until the end of the relevant academic year. 7. The fees which are payable to confirm the reservation on the programme for stipulated academic year cover the registration and kit costs for the year. In the event of cancellation before the academic year starts, i.e. before registration, we may impose a cancellation fee. The following will have regard to the percentage of these initial payments for the relevant programme retained by Elizabeth Galloway Academy of Fashion as a Cancellation Fee: a. For the Introduction to Fashion i. Before 31st December 50% of initial payment ii. Before 30th January 75% of initial payment iii. From 30th January to date of registration 100% of initial payment b. For the 3 year Diploma and Degree (new first years) i. Before 30th September 50% of initial payment ii. Before 31st October 75% of initial payment iii. From 31st October to date of registration 100% of initial payment c. For the 3 year Diploma and Degree (returning students) i. From 21st December to date of registration 100% of initial payment d. For the Advanced Diploma (Specialisation year) i. From 21st December to date of registration 100% of initial payment
Signature of person responsible for payment of fees
*
Signature of Witness
*
Proof of Payment
*
Max. file size: 64 MB.