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  • 119 1st Road, Linbro Park, Sandton, Gauteng, SOUTH AFRICA
    P.O. Box 119, Linbro Park, 2065, Gauteng, SOUTH AFRICA
    Telephone: (+27) 11-608-1584/2206
    Fax: (+27) 86-671-7281
    e-mail: modmont@global.co.za
    web site: http://www.montessoriint.com

  • 2027 FULL TIME COURSE APPLICATION FORM

    • The applicant and the applicant's parent/guardian (when the applicant is under 21 years old) is/are required to complete the application form and submit it to The College, together with the admission documentation detailed in the checklist to follow.
    • In order to facilitate the efficient processing of applications, applicants may email a scanned copy of the application form and admission documentation to modmont@global.co.za; however, the original copy of the application form must be submitted upon acceptance.
    • Please print clearly.
    • Please do not leave any of the fields blank. If there are any fields that do not apply to you, please enter 'n/a'.
    • In the event that there is insufficient space for you enter the relevant details, please add the remaining information to the admission documentation.
    • Please ensure that the bottom right hand side of each page is initialled by the applicant and the applicant's parent/guardian (when the applicant is under 21 years old) in the space provided.
  • Admission Documentation Checklist
  • THE COLLEGE & SCHOOL OF MODERN MONTESSORI
    Reg. No. CK94/21728/2
    MEMBERS: A.A. DARBY, P.A. DARBY, O.C. DARBY, A.M. DARBY
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  • FULL TIME COURSE APPLICATION FORM ~2027 ACADEMIC YEAR

  • 1. Applicant's Details

  • Title: (✔)
  • Marital Status:
  • Date of Birth:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender:(✔)
  • SA Resident: (✔)
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 1.1 Parent/Guardian Details (students under 21 years old) / Spouse Details (married students)

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
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  • FULL TIME COURSE APPLICATION FORM ~2027 ACADEMIC YEAR

  • 1.2 Educational Background and Qualifications

  • Secondary Education

  • Standard Achieved:
  • Untitled Matrix
    Rows

  • Tertiary Education (if applicable)

  • Other Training/Courses (if applicable)

  • Learning Difficulties/Barriers to Learning (if applicable)

  • 2027 FULL TIME COURSE APPLICATION FORM
  • 3
  • Initials of Applicant & Parent/Guardian
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  • FULL TIME COURSEAPPLICATION FORM~2027 ACADEMIC YEAR

  • 1.3 Professional/Working Background

  • 1.4 Medical Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Does the applicant/student have any allergies? If yes (✔), give details.
  • Does/has the applicant/student suffer/suffered from any illness or disability? If yes (✔), give details.
  • Is the applicant/student receiving any medical treatment or chronic medication for any condition? If yes (✔), give details.
  • Has the applicant/student suffered, or been treated for, any psychological or emotional upset? If yes (✔), give details.
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  • FULL TIME COURSEAPPLICATION FORM~2027 ACADEMIC YEAR

  • 2. Indemnity Form

  • In the case of the applicant being under 21 years old, this form must be completed by the applicant's parent/guardian.
  • I, ________________________________________________________________________________ acknowledge that The College of Modern Montessori
    cannot accept any liability for mishap, loss or injury which may be suffered during attendance at The College, or practicum
    experience, or during participation in any pre-arranged excursions, or extra-curricular activities.
  • I accept that all reasonable precautions will be taken to ensure the safety and welfare of each student and that I shall be
    held responsible for the payment of medical and/or hospital accounts where applicable, should any injury or loss be
    sustained by myself/my child. I specifically indemnify and hold The College and its staff blameless against any claims of
    any nature arising out of any injury, damage or loss sustained in pursuance of the aforesaid participation.
  • I hereby indemnify The College of Modern Montessori in respect of all occurrences relating to the above.
  • Date (dd/mm/yy):
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2027 FULL TIME COURSE APPLICATION FORM
    5
  • Initials of Applicant
    & Parent/Guardian
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  • FULL TIME COURSE APPLICATION FORM ~2027 ACADEMIC YEAR

  • 3. 2027 Fees: R73 000.00 + $240.00 (MACTE registration fee)

  • Please consult section 20 of the Prospectus for further details

  • 3.1 Details of Person Responsible for Payment

  • Person responsible for payment of course fees: (✔)
  • If other, please supply the following details and attach a copy of ID document:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • 3.2 Deposit

  • Full Time Course Deposit Payable:
  • R 9 000,00
  • Payment Date:
     - -
    2 digit month, 2 digit day, 4 digit year

  • 3.3 Tuition Fees

  • Select 1 of the following payment options: (✔)
  • Select 1 of the following payment methods: (✔)
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  • FULL TIME COURSEAPPLICATION FORM~2027 ACADEMIC YEAR

  • 4. Terms and Conditions

  • I, the undersigned:
    • Hereby certify that the information provided on this application form is true, complete and accurate.
    • Hereby certify that the address as completed on page 2 has been elected as my domicilium citandi et executandi. Should this address differ from the address detailed on page 6, such address will be used as the domicilium citandi et executandi.
    • Hereby irrevocably certify and confirm that I am responsible for payment of the course fees in accordance with the terms and conditions as set out herein and in The College of Modern Montessori Prospectus.
    • Have read The College of Modern Montessori Prospectus and accept enrolment at The College according to the philosophies, policies and conditions laid down therein.
    • Understand that The College reserves the right in its sole discretion to amend and/or alter any of the provisions of The College of Modern Montessori Prospectus.
    • In the event that The College is required to take any action whatsoever to enforce its rights under this agreement, I acknowledge and agree to be liable for all costs incurred by The College in so doing, including but not limited to, attorney dient costs, and collection and tracing charges and I furthermore agree to The College listing my personal details adversely with the National Credit Bureau.
    • Endose the deposit of R9 000.00 on the understanding that it will be refunded to me in full if the application does not result in acceptance for the course.
    • Understand that the deposit of R9 000.00 will not be refunded once the application has resulted in acceptance for the course and that I will be bound to pay the full course fee.
    • Understand that the MACTE registration fee of $240.00 (US Dollars) is due and payable within one month of the commencement of the course.
    • Understand that failure to attend dasses and/or to submit the requisite course work and/or to achieve the minimum pass grade, for any reason whatsoever, will not reduce my liability for the full course fee, except with the written consent of The College.
    • Understand that course material will not, under any circumstances whatsoever, be released to students whose fees are overdue.
    • Are aware that annual fees are payable in advance, on or before orientation.
    • Are aware that quarterly fees are payable in advance, on or before the following dates: 1st Quarter: 1st March 2nd Quarter: 1st May 3rd Quarter: 1st August 4th Quarter: 1st November
    • Are aware that monthly fees are payable in advance, on or before the first day of each month and are payable over nine months (1st March – 1st November).
    • Accept that a late payment penalty fee of 10% is charged on overdue accounts.
    • Hold myself accountable for the prompt payment of tuition fees and for any late payment penalties added onto overdue accounts.
    • Understand that The College reserves the right to refuse admission to a student with outstanding fees.
    • Understand that fees are due irrespective of absenteeism due to illness, vacation or for any other reason whatsoever.
    • Undertake to reimburse The College for any damage to School/College property that may be caused by the student.
    • Understand that while every reasonable effort will be made to prevent losses or damage to the student's property, The College cannot be held liable.
  • Date:
     - -
    2 digit month, 2 digit day, 4 digit year
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  • FULL TIME COURSE
    APPLICATION FORM
    ~2027 ACADEMIC YEAR

  • 5. Credit Check Permission

  • consent and allow The College of Modern Montessori to access my full consumer profile on the database held
    by any credit bureau.
  • Date:
     - -
  • Confidentiality Note: This page and any accompanying documents contain confidential information
    intended for a specific individual and purpose. This telecopied information is private and protected by
    law. If you are not the intended recipient, you are hereby notified that any disclosure, copying or
    distribution, or the taking of any action based on the contents of this information is strictly prohibited.
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