EDUINSTITUTE

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Student Wellness Services

We provide medical and counseling services by appointment. Welcome to EDUINSTITUTE’s Student Wellness Services! We are offer medical care, mental health support, and wellness education.
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EDUINSTITUTE Application Form

Application Form

SECTION A: PERSONAL DETAILS

Title

Name

Birth Date

Gender

Male Female Trans

Race

Home Language

Are you a South African citizen?

Yes No

Are you a South African permanent resident?

Yes No

Martial Status

If you are a citizen or permanent resident in a country other than South Africa, please provide details here:

Citizen Permanent Resident

SECTION B: PROGRAMMES OF STUDY FOR WHICH YOU ARE APPLYING

Please Choose Higher Certificate

SECTION C: YOUR CONTACT DETAILS

Address

Contact Details

SECTION D: PARENT / GUARDIAN CONTACT DETAILS

Title

Name

Birth Date

Address

Contact Details

SECTION E: FEE PAYER INFORMATION

If your Fee Payer is also your parent/guardian, please fill in the fee payer details below

Title

Name

Birth Date

Address

Contact Details

Relationship to you?

ID Copy

Matric Certificate