APPLICATION FORM 2023

ID PHOTOGRAPH
TO AFFIXED
HERE

FORT COX AGRICULTURE AND FORESTRY TRAINING INSTITUTE

P.O. BOX 2187, KINGWILLIAMSTOWN, 5600,
EASTERN CAPE, REPUBLIC OF SOUTH AFRICA
Tel: 040-653 8033/4 Fax: 040- 653 8036

APPLICATIONS ARE OPEN FROM 01 JULY 2022 – 31 OCTOBER 2022

LATE APPLICATIONS ARE OPEN FROM 01 NOVEMBER 2022– 30 NOVEMBER 2022

APPLICATION FEE:

A non-refundable APPLICATION FEE of R200.00 must be paid for applications submitted within the period
of 01 JULY 2022 – 31 OCTOBER 2022.

The LATE APPLICATION FEE after the closing date is R300.00 and must be paid for applications
submitted within the period of 01 NOVEMBER 2022 – 30 NOVEMBER 2022.
BANKING DETAILS:
Please attach the original deposit slip to the application form and keep a copy for future reference.
ACCOUNT NAME - FORT COX COLLEGE OF AGRICULTURE AND FORESTRY
BANK NAME - FIRST NATIONAL BANK
BRANCH NAME - KING WILLIAMS TOWN
BRANCH CODE - 210519
ACCOUNT NUMBER - 62000658049
REFERENCE - APPLICANT’S SURNAME AND FULL NAME

CHECK LIST FOR DOCUMENTS

Please attach certified copies of the following documents:

 National Senior Certificate (NSC), National Certificate Vocational (NCV)

 Diploma in Agriculture/ Forestry
 Academic record and certificate of conduct if transferring from another Agricultural college or
institution.
 Identity document (Applicant)
 Identity document (Parent)
 A study permit and proof of permanent residency must be submitted by International application.
 SAQA Clearance letter (international qualifications)
 Proof of Payment Application fee
 Proof of Address (E.g. Municipal letter Account, Store account letter etc.)


NB: All applications must sent via post, or emailed no faxed application will be considered. For general enquires please send
an email to [email protected]

A. PERSONAL DETAILS:
PLEASE NOTE: It is the responsibility of the student to make sure that the personal details and contact details are kept up to date, all changes
thereof must immediately be reported to the to the Student Bureau office.
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 APPLICATION FORM 2023

Title: MR MISS MRS DR REV Initials: Year: 2 0 2

Surname:

First Names:

Alternate Names:

Birth Date: d d m m y y y y Gender: female male

ID Number: Passport Number:

Marital Status: single married divorced widow/er Preferred Language: English alternate
Current Occupation:
Home Language:

Study Permit No (if not SA Citizen):

B. CITIZENSHIP / ETHNICITY:
Ethnic
Group: White Coloured Indian Black Asian
Citizenship
C. FINANCIALS:
Source of Private Bursary Employer Employer Name:
Parents Government Required? yes no
Funding: body

D. MISCELLANEOUS:
Talk at Our Promotional Community Other
Where did you hear about the College? : Friends Teachers Family Radio Ma gazines
School Website Items Newspaper (please specify)

E. POST SCHOOL DETAILS:

Name of College/Institution
currently studying: Student/Exam No:

Matric Date y y y y m m Matric Aggregate:

Student
Reason for Date Signature
CANCELLATION: confirming
Cancellation: Cancelled:
Cancellation:
F. CONTACT DETAILS OF STUDENT:
Number and
Street

Student Postal Suburb

Address:
Town Postal code:
Province
Municipality
Number and
Street

Residential Suburb
Address:
Town Postal code:

Province Municipality

Contact Telephone Cell Number Home Number Work Number

Numbers:

E-mail Address:

G. CONTACT DETAILS OF PARENT / GUARDIAN / PERSON WHO MUST RECEIVE:

Title MR MISS MRS DR REV Initials Surname

PLEASE NOTE: It is the responsibility of the student to make sure that the personal details and contact details are kept up to date, all changes
thereof must immediately be reported to the to the Student Bureau office.
Revised 26 July. 2022 Page|2
 APPLICATION FORM 2023

Church Community Police Social

Relationship of next of kin: Aunt Brother
Leader Leader
Cousin Father Grandfather Grandmother Guardian Mother Partner
Officer
Sister
Worker
Spouse Uncle

Number and
Street

Suburb
Physical Address:
Town Postal code:
Province
Municipality
Contact Telephone
Numbers: Cell Number Home Number Work Number

E-mail Address:
H. DISABILITIES: Do you have a medical condition or disability? If so, please indicate with an ‘x’ below:
Severe Intellectually
None Behavioral Disorder Deaf/Blind Disabled Hard of Hearing Partially Disabled
Disabled
Mild/Moderate
Attention Deficit disorder Blind Deaf Psychiatric Disorder Specific Learning Disabled
Intellectually Disabled
Autistic Spectrum Profound Intellectually
Cerebral Palsied Epilepsy Multiple Disabled Dyslexia
Disorder Disabled
Other Please indicate:

I. CURRENT EMPLOYMENT STATUS (Please indicate with an ‘x’)

SELF -
EMPLOYED UNEMPLOYED STUDENT
EMPLOYED
INDUSTRY POSITION IN COMPANY
NAME OF
PERIOD IN POSITION
COMPANY
J. COURSE PREFERENCE (In the order of preference, please indicate two Diploma options you are interested in studying):

DIPLOMA APPLYING FOR:

FIRST CHOICE:

SECOND CHOICE:

ADVANCE DIPLOMA APPYING FOR:

FIRST CHOICE:

SECOND CHOICE:

DECLARATION BY APPLICANT
 I declare that the information, which I have furnished, on this form is, to the best of my knowledge true and correct
and any false declaration may result in my application being rejected.

 I hereby exempt the Fort Cox Agriculture and Forestry Training Institute from any liability resulting from my own
negligence or indiscipline.

 If I am admitted I undertake to:

a. Read and abide by all official notices to students.
b. Reside at the residence to which I may be allocated into.
c. I shall be liable for any damage to the Institution property caused by myself.
d. I hold myself responsible for the payment in full of all fees and other charges regardless of sponsorship.
e. I shall abide by the rules of the institution and adhere to them as enshrined in the prospectus and other institutional

SIGNATURE OF APPLICANT DATE

PLEASE NOTE: It is the responsibility of the student to make sure that the personal details and contact details are kept up to date, all changes
thereof must immediately be reported to the to the Student Bureau office.
Revised 26 July. 2022 Page|3
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