Mpaka Student Accommodation Application Form

Mpaka Student Accommodation Application Form

Please fill out the application form carefully
Year of Application
Year of Application*
Personal Information
Head-to-shoulder photo (ID like photo)*

Please do not wear sunglasses or cap
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ID Card 1st Side or Book*

Please send both sides of the ID Card
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ID Card 2nd Side*

Please send both sides of the ID Card
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Full Names*

Title (Mr/Ms/Dr)First NameMiddle NameSurname
Student Number*
ID Number*
Gender*
Birth Date

MonthDayYear
Ethnicity*
Home Language*
E-mail*
example@example.com
Phone Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical history (Optional)
This is optional. However, it would be at our advantage to know more about your conditions.
Parent/Guardian Details
Full Names*

Title (Mr/Ms/Dr)First NameMiddle NameSurname
ID Number*
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Education Background

List your current or previous university/college/schools, beginning with the most recent

University/College Course of Study
Course of Study name*
Funder
Name of funder*
Select the funder
Other
If selected other, please specify the funder
Activity Information
Tell us more about yourself
What activities do you like? What sport do you play?
Residence and room selection
Residence*
Select the residence you wish to stay in (browse on the website to make an informative decision)
Room type*
LEASE AGREEMENT

Please note that lease agreements will be signed on the NSFAS online portal.

NB:
1. Please note that provided you have left your belongings in the residence for storage, with the promise of coming to reside with us in 2025, signing this form is a commitment to stay with us.
2. Provided that you have changed your mind to stay with us, you shall be charged R1500 for the storage fees, and your items will be released when this amount is fully paid to us.
Signature*

Clear
Name of the person that referred you:

First NameSurname
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Should be Empty:

Parent/Guardian Details