CSC Online Course Registration Form Level 2 August 2, 2021

COMMUNITY SERVICES CHAPLAINCY ONLINE TRAINING COURSE REGISTRATION FORM

LEVEL 2 -Covid friendly
Student Registration Form

Fill out the form carefully for registration. We will protect your information. That's a promise we will not break. We're also POPIA compliant.
Student Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Residential Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Company or Denomination *
Work or Church Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail *
Mobile Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
Work Number

Area Code Phone Number
Courses
Did you complete level 1 and passed?

Yes No
If you did level 1 when?
Do you have a Criminal record? *
If You said yes please explain with case numbers etc.
Additional Comments
Did you pay the mandatory fee of R300? *
Registration cannot be completed without your proof of payment. Fees should be paid into: Full Gospel Church General Account with ABSA Bank NR 600169599, Branch 632005, ref Name+OnlineCSC
If You said no please explain :
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

COMMUNITY SERVICES CHAPLAINCY ONLINE TRAINING COURSE REGISTRATION FORM