APPLICATION FOR THE REGISTRATION OF LEARNERS FOR HOME EDUCATION

APPLICATION FOR THE REGISTRATION OF LEARNERS FOR HOME EDUCATION
Year*
APPLICATION FOR THE REGISTRATION OF LEARNERS FOR HOME EDUCATION
1.This application form must be completed in full by the parents/ guardian of a learner.

2.A separate form must be completed for each learner, accompanied by the following required documents : Please note: all certified copies must not be older than 3 months

Certified copy of the learner’s birth certificate

Certified copy of the learner’s last school report signed by the principal

Certified copy of the parent’s ID

In case of foreign nationals certified copies of passport /study permit/work permit/ Asylum document is required.

Certified copy of the transfer certificate from previous school (if Applicable)

In case of a learner with special needs, attach certified copy of assessment

document or Referral letter from the medical practitioner.

Motivation why the parent wishes the learner to be educated at home.

Full details of the educational programme (subjects, teaching hours per subjects,

assessment, extra mural activities, excursions, library, programme use of tutor

Instructions on how to complete this form:

Complete the form by ticking check box and Write in the text box where applicable

Select relevant option from given options in a dropdown-list

Submit the form with the required documents to:gdehomeeducation@gauteng.gov.za
- Note: Submission of the application form does not imply that the learner is registered with Provincial Department of Education.

Are both parents still alive?
Are both parents still alive?*

YesNoNo contact

Disability
If learner suffers from Other disability please Specify
Assessed by registered professional practitioner

Previous Education
Province of last educational institution attended*
Name of the last educational institution (Type HOMESCHOOL if student was homeschooled)
Grade completed (if applicable)
The physical address of previous educational institution*
Contact No. ofprevious educational institution: (if applicable)

Home Education Grade Registering
Grade for which application is being made*
Curriculum to be used*
Subjects Offered (List all subjects, Separated by comma)*
Home Address
Reasons for choosing home education*

Distance to schoolChildren With Special needs Nomadic lifestylesDissatisfaction with public schoolReligious ConvictionsFinancial ConsiderationLack of Admission to public ordinary SchoolsNomadic Lifestyle

Parent 1 /Legal Guardian Details
Title*
First Names*
Surname*
South African Citizen*
South African Identification Number*
Passport Number: (if applicable)
Country of Origin(If not from South Africa)
Population Group*
Highest Qualification Obtained*
Employment Status: (Please tick appropriate box)*
Marital Status:(Please tick appropriate box)*
If you are a member of a Home Education Association, please provide the*
NA
Lives with the Learner*
Relationship With Learner*
Other Specify
Telephone Number
Cell Number*
Email Address*
example@example.com
Street*
House No.*
Farm
Complex/ Building
Area Code*
Town*

Parent 2 /Legal Guardian Details
Does PARENT 2 stay at a different address than parent 1?
Title
Name

Full Names5.3 Surname
South African Citizen
South African Identification Number
Passport Number: (if applicable)
Country of Origin(If not from South Africa)
Population Group
Highest Qualification Obtained
Employment Status(Please tick appropriate box)
Marital Status: (Please tick appropriate box)
If you are a member of a Home Education Association, please provide the
N/A
Lives with the Learner
Relationship With Learner
If other specify
Cell Number
Phone Number
Email
example@example.com
Street
House No
Farm
Complex/ Building
Area Code
Town

Declaration By Parent Or Guardian
I (name of parent/guardian) hereby declare that I *
have read section 3(1) and 51 of the South African Schools Act, 1996 together with the Policy on Home Education. I further declare that I understand and accept the responsibility to provide, monitor and assess the home education of my child and that I have supplied full and correct information.
Initials and Surname of the Parent/Guardian*
Date

DayMonthYear
Date
Signature*

Clear
Should be Empty: