119 1
st
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) 11-608-1586 e-mail:
modmont@global.co.za
web site:
http://www.montessorint.com
2027 LOWER ELEMENTARY (6 – 9) 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 (before orientation).
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.
Name of Applicant:
How did you find out about The College of Modern Montessori?
Rows
or n/a
Office Use
1. Application form signed by the applicant (and parent/guardian, if applicant is under 21)
2. Copy of the applicant's ID document
3. Copy of the ID document of the applicant's parent/guardian (if the applicant is under 21)
4. Copy of the ID document of the person responsible for payment
5. If the applicant is not a South African citizen, a copy of the applicant's passport, a copy of the passport of the applicant's parent/guardian/spouse and proof of residence is required.
6. Confirmation of payment of the deposit
7. Copy of matric certificate (or most recent transcript of grades for Grade 12 applicants)
8. Copies of early childhood qualification and other certification(s) previously obtained (if any)
9. Two colour ID photographs
10. Any other pertinent supporting documentation (for example: testimonials, references, awards/accolades, curriculum vitae, education specialist assessment report)
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LOWER ELEMENTARY COURSEAPPLICATION FORM~2027 ACADEMIC YEAR
1. Applicant's Details
Title:
Miss
Mrs
Ms.
Mr
Dr
Rev.
Prof.
Other
First Names:
Surname:
Marital Status:
Single
Married
Divorced
Widowed
Name(s) and Age(s) of Child(ren):
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age:
Gender:
Male
Female
ID Number:
SA Resident:
Yes
No
Nationality:
Passport Number:
Race:
Religion:
Home Language:
Other Language(s):
Residential Address:
Postal Address:
Tel (Home):
Format: (000) 000-0000.
Cell:
Format: (000) 000-0000.
Fax:
Format: (000) 000-0000.
Primary Email:
example@example.com
Alternative Email:
example@example.com
1.1 Parent/Guardian Details (students under 21 years old) / Spouse Details (married students)
Surname:
First Name:
ID Number:
Relationship to Student:
Tel (Home):
Format: (000) 000-0000.
Cell:
Format: (000) 000-0000.
Tel (Work):
Format: (000) 000-0000.
Email (Personal):
example@example.com
Email (Work):
example@example.com
Residential Address:
Postal Address:
Occupation:
Employer:
Employer's Address:
Employer's Email:
example@example.com
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LOWER ELEMENTARY COURSEAPPLICATION FORM~2027 ACADEMIC YEAR
1.2 Educational Background and Qualifications
Secondary Education
Name of School:
Standard Achieved: (✔)
Matric Certificate
University Entrance Pass
Other
Year of Matriculation:
Final Result: (✔)
Untitled Matrix
Rows
If applicant does not have a matric certificate, specify details (include standard achieved, subjects and grades):
Early Childhood (3-6) Montessori Training & Qualification
Please specify the tertiary education institution; course description, qualification (or standard achieved); year of study:
Other Training/Courses (if applicable)
Please specify the details of any other training undertaken. Provide a description of the training and the year of study.
Learning Difficulties/Barriers to Learning (if applicable)
In the event that you have experienced any learning difficulties in the past, please provide details:
2027 LOWER ELEMENTARY (6-9) COURSE APPLICATION FORM
3
Initials of Applicant
& Parent/Guardian
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1.3 Professional/Working Background
Please provide a brief history of your Montessori work experience (if any).
1.4 Medical Information
Emergency Contact Person:
Telephone Number:
Format: (000) 000-0000.
Cell Phone Number:
Format: (000) 000-0000.
Family Doctor:
Telephone Number:
Format: (000) 000-0000.
Medical Aid Company:
Membership No:
Does the applicant/student have any allergies? If yes (✓), give details.
Yes
No
Does/has the applicant/student suffer/suffered from any illness or disability? If yes (✓), give details.
Yes
No
Is the applicant/student receiving any medical treatment or chronic medication for any condition? If yes (✓), give details.
Yes
No
Has the applicant/student suffered, or been treated for, any psychological or emotional upset? If yes (✓), give details.
Yes
No
Please specify any other relevant information pertaining to the applicant's/student's health and well-being.
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LOWER ELEMENTARY COURSE APPLICATION 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.
Signature of Applicant/Parent/Guardian
Print Name:
Date (dd/mm/yy):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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LOWER ELEMENTARY COURSE APPLICATION FORM ~2027 ACADEMIC YEAR
3. 2027 Fees: R63 000.00 (please consult the prospectus for further details on payment options)
3.1 Details of Person Responsible for Payment
Person responsible for payment of course fees:
Applicant
Parent/Guardian
Other
If other, please supply the following details and attach a copy of ID document:
Name
First Name
Last Name
ID Number:
Relationship to Pupil:
Home Tel:
Format: (000) 000-0000.
Cell Phone Number:
Format: (000) 000-0000.
Work Tel:
Format: (000) 000-0000.
Email Address:
example@example.com
Residential Address:
Postal Address:
Occupation:
Name of Employer:
Employers Address:
Employers Telephone:
Format: (000) 000-0000.
Email (w):
example@example.com
3.2 Deposit
Part Time Lower Elementary Course Deposit Payable:
R 8 000.00
Amount Paid:
Payment Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Payment Method:
3.3 Tuition Fees
Select 1 of the following payment options:
Option 1: Annual Payment
Option 2: Quarterly Payments
Option 3: Monthly Payments
Select 1 of the following payment methods:
Cheque
Credit Card
Direct Deposit
EFT
Post-dated Cheques
Future Dated EFT
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LOWER ELEMENTARY COURSE APPLICATION 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 client 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 R8 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 R8 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 failure to attend classes 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:
1
st
Quarter: 1
st
February
2
nd
Quarter: 1
st
April
3
rd
Quarter: 1
st
July
4
th
Quarter: 1
st
October
Are aware that monthly fees are payable in advance, on or before the first day of each month and are payable over ten months (1
st
February – 1
st
December).
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.
Name of Person Responsible for Fees:
Relationship to Student/Applicant:
Signature:
Signed at:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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