Academic Mentorship Program
Name Of Student
*
First Name
Last Name
Name Of Parent (if applicable)
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Education Status
*
Gr. 8
Gr. 9
Gr. 10
Gr. 11
Gr. 12
College
University
IF you selected College Or University, please state the degree that you are studying towards.
*
Please select the applicable option
*
Academic Mentorship Program (One-Year)
Academic Mentorship Sessions (non-program)
Sports Performance Counselling
Type of Payment Preferred for Academic Mentorship Program (One-Year)
Once-Off (R8999-00)
3-Month Down Payment (R3000-00 p/m)
6-Month Down Payment (R1500-00 p/m)
9-Month Down Payment (R1000-00 p/m)
Submit
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