ACTIPApplicationForm

ENROLMENT APPLICATION FORM - ADVANCED CERTIFICATE IN INTERMEDIATE PHASE TEACHING 2025/2026

Edutel Higher Education is registered with the Department of Higher Education and Training until 31 December 2027 as a private higher education institution under the Higher Education Act, 1997. Registration Certificate No. 2017/HE07/001.· By completing and submitting this enrolment application form, you are applying to be enrolled as a student for a Course(s) offered by Edutel Higher Education.· In this application, “we”, “us” or “our” refers to Edutel Higher Education (Proprietary) Limited and “you” or “your” refers to the individual described in section A of this application.· This application includes the Terms and Conditions attached in Appendix 1.· You must complete all sections in full and sign in full where indicated.· You must provide us with a certified copy of your ID, latest salary advice and certified copies of your qualifications with your application. Also include proof of computer literacy course, if attended. Please ensure that the documents you submit are not password protected and if it is, that you provide us with therevelent password.
Student Number: ____________________
Section A - Your Personal Details
Student Name*

TileSurnameFirst Names
Age (years)*
Sex*
Marital Status*
Race*
Home Language*
Citizen Status*
Disability Status*
If yes, please specify
ID Number*
SACE Registration Number
Postal Address*

Postal Address

Street Address Line 2

CityState / Province

Postal Code
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Phone Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
Email Address*
Employment Information
Are you currently employed as an educator?*

YesNo
If yes, what is your position?
Province of employment
Name of school
Employer Telephone Number

Area CodePhone Number
Relative's Information (not living with you)
Relative's Name*

First NameLast Name
Relative's Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Relative's Number (H)*

Area CodePhone Number
Relative's Number (W)*

Area CodePhone Number
Relative's Fax Number

Area CodePhone Number
Relative's Employer*

Section B - Your Scholastic/Tertiary Qualifications
Highest Grade Passed*
Other Certificates Completed
Diplomas Completed
Degrees Completed
You must be Computer (ICT) Literate to complete the qualification. Are you Computer (ICT) Literate?*
Do you have a certificate to prove it? If yes, please upload it here

Browse Files

Cancelof
If you are computer (ICT) literate but don't have a certificate to prove it, sign here to confirm that you are computer literate - Simply use your mouse/laptop touch pad or finger to sign in the box below.
Do you have access to a*

ComputerLaptopiPadTabletNothing
If you are not computer (ICT) literate when you register for the ACT in Intermediate Phase Teaching, you are requested to complete the declaration below.

I hereby declare that I am aware that I must be computer (ICT) Literate and I undertake to complete the online Computer Literacy workshop that I will receive after registration in order to acquire the skills needed to complete the ACT in Intermediate Phase Teaching. I need to have my own computer with sound or a laptop including data/Wi-Fi to attend the training.

If I do not complete the online ICT workshop presented by Edutel, I undertake to provide Edutel with evidence that I have attended another computer literacy programme at a registered, reputable, training institution.
Signature - Simply use your mouse/laptop touch pad or finger to sign in the box below. *

Section C

If you are married in community of property, your guardian or spouse (if applicable) must complete the following declaration:
Are you married in community of property?*
Spouse Name*
Spouse ID Number*
Spouse Occupation*
Spouse Physical Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Spouse Work Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
I as guardian or spouse of the student in Section A of this application, hereby declare that this application is being made with my permission, and that, where I am the guardian, I hereby bind myself as surety for, and co-principal debtor to the student in Section A of this application for the due and punctual performance of the said student’s obligation arising out of this agreement.
Signature of spouse - Simply use your mouse/laptop touch pad or finger to sign in the box below.*

Section D
Course required (Tick the option you choose)*

Advanced Certificate in Intermediate Phase Teaching: Mathematics, Science and TechnologyAdvanced Certificate in Intermediate Phase Teaching: Life Skills and Social Science
Indicate that you are aware that you need to have your own dedicated e-mail and you need to have access to the internet to access our online Learner Management System (Edutel Online).*

Yes, I am aware
Signature - Simply use your mouse/laptop touch pad or finger to sign in the box below.*
How will you be paying for the Advanced Certificate in Intermediate Phase Teaching?*

Cash (one payment of R23 200.00)3 Consecutive payments of R7 733.33Fundi Study Loan (32 instalments of R1 073.45) NOTE: Fundi Study Loans are for government employees onlyShould you not qualify for a Fundi Study Loan, you can pay via Edutel debit order (deposit R5 800.00 and 18 installments of R1 288.88)
Note: Students who pay cash or via Fundi Study Loans receive 20% discount on the course fee of R29 000.00.
Should you be paying cash in full, in 3 consecutive payments or via the debit order, please attach proof of payment here. Edutel Higher Education banking details: Bank: ABSA Account Holder: Edutel Higher Education Branch Code: 630156 Account No: 407-015-3037 Please include your ID number as reference when making a deposit.*

Browse Files

Cancelof
Should you be paying via Fundi study loan, please download the form here Download the Fundi Application Form, complete it and upload the completed application form below.
Upload the completed Fundi application form here*

Browse Files

Cancelof
LEVEL, CREDITS AND LEARNING COMPONENTS ASSIGNED TO THE QUALIFICATION
Total Qualification Credits – 120 / 135

ALL modules are compulsory EXCEPT for the First Additional Language modules where students choose their First Additional Language.
Electives: Choose one First Additional Language (Please tick the language of your choice) - 15 Credits*

Afrikaans IAFA 630English IEFA 630

Section E
May we contact you via SMS or email?*

SMSEmailOther
Which social media do you use?*

FacebookTwitterWhatsappSMSOther
If you have another number for Whatsapp other than the cellphone number you already listed, please indicate it here:

Section F - Debit Order Mandate

AUTHORITY AND MANDATE FOR DEBIT ORDER PAYMENT INSTRUCTIONS – Must be completed by all applicants, unless you pay cash for your course.
Authority given by (name of account holder)*
Address of account holder*

Street Address

Street Address Line 2

CityProvince

Postal Code
Bank Name*
Branch Name & Town*
Branch Number*
Account Number*
Type of account*

Current (Cheque)SavingsTransmission
Your salary pay day*
Today's date*

MonthDayYear
Date
REFER TO OUR CONTRACT DATE (“the Agreement)”I/we hereby authorise you to issue and deliver payment instructions to your banker for collection against my/our above mentioned account at my/our above mentioned bank on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement.
Signature - Simply use your mouse/laptop touch pad or finger to sign in the box below.*
Signature of surety - Simply use your mouse/laptop touch pad or finger to sign in the box below.

Section G - Credit Card (5.7% levy payable)

Please complete if you would like to pay your deposit or cash in full amount via credit card. Alternatively click next
Credit Card Type
Total Cash Amount
Budget account

3 Months6 Months12 Months24 Months
Name as it appears on card
Credit Card Number
Expiry Date on Credit Card
Last 3 digits on back of credit card
Signature of Cardholder - Simply use your mouse/laptop touch pad or finger to sign in the box below.

Section H - Very important: If not completed it could delay the dispatch of your material

To dispatch your material via PAXI, which means you will collect your material at your nearest PEP store,we need the following information.
At which PEP store branch do you wish to collect your study material? Please provide the branch name, town and province.*

Section I
By signing below, you signify your acceptance of the Terms and Conditions that apply to this application, as set out in Appendix 1 to this application below.
Signed at (place)*
Today's Date*

MonthDayYear
Date
Signature of Student - Simply use your mouse/laptop touch pad or finger to sign in the box below.*
Please indicate the province and town where you prefer to write exams. New Examination Centres can be considered, pending the number of students wanting to write examinations at these centres. A written request can be directed to the Examination Officer. Edutel Higher Education will consider the best interests and safety of students when planning for examinations. This may lead to examinations not being held at actual centres, but will be replaced with online examinations. In such cases, students will be informed of such decisions well in advance. Note: If an insufficient number of students register to write examinations at a specific centre, students will be redirected to an alternative centre. If a student insists on writing at the specific centre (although there are not a sufficient number of students registered at that centre), they can enquire with the Head of Examinations as to what the requirements will be to make that possible.*
Declaration
I am fully aware that the programme I have enrolled on, that is, the Advanced Certificate in
Intermediate Phase Teaching, SAQA ID: 120903, NQF 06, is registered with the Department of Higher Education and Training to Edutel Higher Education (Pty) Ltd as indicated on the registration certificate dated 30 November 2021.
Today's Date*

MonthDayYear
Date
Student Signature*
Please upload a certified copy of your ID here*

Browse Files

Cancelof
Please upload a certified copy of your qualifications here*

Browse Files

Cancelof
1. If paying via Fundi study loan - please upload a recent copy (not older than 2 months) of your salary advice here. 2. If paying via debit order, please upload a recent copy of your bank statement confirming your bank account details here*

Browse Files

Cancelof
Workplace Confirmation Letter
The following workplace confirmation letter needs to be submitted along with your application. Download a copy of the letter to be completed here: Workplace Confirmation Letter
Submit your completed workplace confirmation letter here. Should you not be able to submitit online now, please send the completed workplace confirmation letter to highereducation@edutel.ac.za

Browse Files

Cancelof
Should be Empty:

ENROLMENT APPLICATION FORM - ADVANCED CERTIFICATE IN INTERMEDIATE PHASE TEACHING 2025/2026

Section A - Your Personal Details

Employment Information

Relative's Information (not living with you)

Section B - Your Scholastic/Tertiary Qualifications

Section C

Section D

Section E

Section F - Debit Order Mandate

Section G - Credit Card (5.7% levy payable)

Section H - Very important: If not completed it could delay the dispatch of your material

Section I

Declaration

Workplace Confirmation Letter