INTERNATIONAL TRAINING COLLEGE - LINGUA

Towards Educatio nal Excellence

NCHE Reg No: R0014 | NQA Accreditation No: 000244

TERTIARY APPLICATION FORM

FOR OFFICE USE

Student Number: Date letter sent:

CVCV
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NQF Level:
HOD Signature:

Recommendations: Admin Signature:

Date captured:
RPL/12/10
Date called
Loan/Bursary/Cash:

CV PLEASE ATTACH THE FOLLOWING DOCUMENTS:

Academic Year Applied for:
Certified copy of ID or Passport
Part-time Certified copy of last Academic records
Mode: Fulltime Distance
Curriculum Vitae
2 Passport Photos
Intake: January June
COURSE CHOICE
First Choice:

Second Choice:

PERSONAL DETAILS
Title: Surname: First names: Initials:

Gender: Country: Date of Birth: ID/Passport No:

CONTACT DETAILS
Cell: Email: Region of Birth:

Residential Address: Postal Address:

Home Language: Marital Status:

GUARDIAN

Cell: Email:

Residential Address: Postal Address:

HIGHEST QUALIFICATION OBTAINED

Name of Institution/School:

Region: Qualification: Year Obtained:

Life skills teacher name & surname: Contact number:

EMPLOYMENT STATUS (if applicable)

Name of Employer: Occupation:

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Postal Address: Telephone:

PAYMENT

Name of Institution or Person

responsible for payments: Relationship:

Employer Name: Cell No: Region:

Residential Address: Email:

PHYSICAL CHALLENGES
Indicate whether physically challenged: Yes No

If answer is yes, please mark (X) on the challenge you are experiencing.

Blind/Visually Impaired Deaf Wheelchair bound

Other (Please specify)

HOW DID YOU HEAR ABOUT US?

Newspaper: Word of mouth: Website: Facebook: Flyer/Brochure: Presentation at School/Company:

Other (please specify):

COLLEGE DETAILS

Physical Address:
961 Hosea Kutako Drive (Opposite Pionierspark Cemetery) Windhoek-West.
P. O. Box 50097, Bachbrecht; Windhoek, Namibia
Tel: +26461-301032/3/4/5 |Email: [email protected] | Website: www.collegelingua.com

Banking Details Office Hours

Account Name: Lingua Consultancy Services 1. For Enquiries
Bank: First National Bank Mondays to Fridays
Branch: FNB Corporate 07:00 – 17:00
Account type: Cheque/Platinum Business Account
Branch Number: 28 18 72 2. For Payments
Account Number: 62034752320 Mondays to Fridays
Swift Code: FIRNNANX 07:00 – 17:00
Reference: Full name and surname
DECLARATION

DECLARATION BY STUDENT IF OLDER THAN 21 YEARS OF AGE:

I, ____________________________________________________________________ (NAME IN FULL of the Applicant/Student) hereby

declare that I fully understand and accept the conditions as set by International Training College-Lingua. Furthermore, I fully understand
that no refunds will be done on payments made and that I will be fully liable for all fees. I therefore undertake personally to the College
to fulfill all the financial obligations to International Training College-Lingua. I also declare not to have any claim against International
Training College-Lingua/Lingua Consultancy Services or any Staff member in case of loss of life, property and/or injury sustained.

Signature: ____________________________ Date: ________________________

(Applicant/Student)

DECLARATION BY PERSON RESPONSIBLE FOR PAYMENT:

I, __________________________________________________________________ (NAME IN FULL of Parent/Legal guardian of

Applicant/Student) hereby declare that I fully understand and accept the conditions as set by International Training College-Lingua.
Furthermore, fully understand that no refunds will be done on any fees paid and that I will be fully liable for all fees.

I, the undersigned _______________________________________________________ (the Parent/Legal guardian of the Applicant)

commit myself to comply with the stipulations of International Training College-Lingua on this document, and I undertake personally to
fulfill all the financial obligations of the Applicant/Student to International Training College-Lingua in respect of the period that the
Applicant/Student will still study at International Training College-Lingua.

I also declare not to have any claim against International Training College-Lingua/Lingua Consultancy Services or any Staff member in
case of loss of life, property and/ or injury sustained.

Signature: __________________________________________ Date: ________________________

(Applicant/Student)

Signature: __________________________________________ Date: ________________________

(Parent/Guardian)

Signature: __________________________________________ Date: ________________________

(Witness)

Signature: __________________________________________ Date: ________________________

(ITCL Staff member)
DECLARATION BY THE APPLICANT

I do hereby:

1. Acknowledge that I understand the provisions of the declaration of this contract and hold myself bound thereby; and all other
provisions of this registration, and by the rules and procedures of International Training College–Lingua for the period they are in
force and acknowledge that they may be altered, during the period that I am a registered student.
2. Understand that I am responsible to ensure that I am enrolled for the correct level, course, mode of study & modules.
3. Acknowledge that I have familiarized myself with the prospectus of the relevant programs and certify that the information given
by me in this form is accurate and complete in all respects.
4. Hold myself responsible for the total payment of tuition fees, notwithstanding the fact that my employer/sponsor has undertaken
to pay full tuition fees thereto;
5. Agree that International Training College–Lingua shall be entitled to recover from me all legal costs incurred in order to enforce its
right under this contract, including, but not by way of limitation, attorney and own client fees and collection charges and all tracing
charges.
6. Fully understand that there will be No Refund on any payments made.
7. Monthly installments must be paid on the last day of each month. Failure to pay before the grace period, which is until the 4th of
each month, will result in a 10% monthly interest fee and the student will not be allowed to attend classes unless the fees are
updated.
8. Accept that a statement issued by International Training College–Lingua Accounts Department shall be proof of full amount owing
for the purposes of legal proceedings.
9. Accept that whilst a student at International Training College-Lingua, my child/I as a student may participate in events, activities or
other situations where College representatives take photographs or video recordings of my participation (“Events”)
10. I understand that by signing this form, I am giving my permission to the College to take and use photographs, video and/or audio
(“recordings”) and use the recordings subject to the terms and conditions below:
11. I hereby give International Training College-Lingua permission to;
a. Take photographs of me/my child and/or to record my/my child’s name, title, voice, image, and likeness In
connection with myself/my child’s participation in College Events; and
b. Use myself/my child’s name, title, voice, image, and likeness in connection with the recordings for the purposes
set forth in paragraph (a).
12. In connection with my grant of permission pursuant to paragraph (11 a) above, I understand that International Training College-
Lingua may use the recordings for the purpose of the College’s education, marketing, alumni, and fundraising activities in any media
to include: magazines, newspapers, trade journals, annual reports, booklets, pamphlets, newsletters, advertisements, and other
promotional materials; classroom and online course materials; the College Website and its related social media sites.
13. The College has no obligation to pay me/my child a fee or royalty regarding the use of the recordings consistent with point 11(a) &
11(b) above.
14. A Minimum of 12 (full-time and part time) students is required for face to face classes
15. Understand that accreditation for some programs is still in progress and therefore register voluntarily

Name of Applicant: _____________________________________________ ID/Passport number: ________________________

Signature of Applicant: ___________________________________________ Date: ____________________________________

Name of Witness: _______________________________________________ Signature of Witness: _______________________

Signature of Sponsor/Employer: _______________________________________________ Date: ________________________

Name of Sponsor/Employer (If applicable): _____________________________________________________________________