Enrolment Application Form

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1 PASSPORT SIZE PHOTOGRAPH OF APPLICANT INSTITUTE OF CULINARY ARTS Farm Calenick, Zevenrivieren Road, Banhoek, Stellenbosch PO Box 6314 U N I E D A L 7612, S OUTH AF RI C A T E L +27 (0) I F AX +27 (0) info@icachef.co.za I website Enrolment Application Form Intake being applied for : January Programme being applied for: (please tick) ICA 3-Year Diploma: Advanced Culinary Arts, Advanced Pâtisserie and Specialist Culinary Field: Product Development or Media Communications & Food Theatre or Events/Restaurant Management & Professional Wine Studies ICA 2-Year Diploma: Advanced Culinary Arts and Pâtisserie ICA 2-Year Diploma: Advanced Pâtisserie and Culinary Arts This form should be completed by the applicant. ALL pages and sections MUST be completed in full. Office use Appl i cati on fee Rati ng Uni form si ze Personal Details Full Name/s Known As Date of Birth Sex Male Female Nationality Home Language Second Language Postal Address Physical Address (H) Chest Measurement cm Code W ill you have your own transport during your first year of studies at the ICA? Yes No W here and how did you hear about the ICA? Institute of Culinary Arts (PTY) Ltd I Company Registration Number 2001/029191/07 I Directors CL Prinsloo, JJ Prinsloo

2 Page 2 of 5 Basic Educational Details School / College Year of Qualification Qualification Level Town / City School / College Tel. Computer Literate Yes No Learning Disabilities Work Experience Details P l e a se i n di cate yo u r w o rk e xp e ri en c e, be gi n ni n g w i th th e m os t r ec e n t ( In cl ud i ng pa r t -tim e o f casual work i f ap pl i c a bl e ) Company name Position Period Employed From: To: Company name Position Period Employed From: To: Sponsor Details P l e a se i n di cate w h o w i l l b e p a yi n g f o r yo u r s tu d i e s: SELF EMPLOYER PARENT GUARDIAN OTHER Please provide the following details of your Sponsor Nature of Business Postal Address Physical Address (H) Code Sponsor s Signature Date Signed

3 Page 3 of 5 Additional Personal Details Please provide the following details of your Father / Step Father / Legal Guardian Occupation (H) Please provide the following details of your Mother / Step Mother / Legal Guardian Occupation (H) General Information Have you had any serious illness during the past five years? Yes No Have you had any serious injury during the past five years? Yes No Are you presently undergoing any medical treatment? Yes No Do you take any medication on a regular basis? Yes No Are you covered by a registered Medical Aid Fund? Yes No Name of Fund Membership No. Principle Member

4 Page 4 of 5 Additional Education Details P l e a se pr o vi d e d et ai l s o f yo u r m o st re c en t s chool E xam i n a ti o n R e s ults Subject Grade Symbol / Level Referee Details Please provide details of at least two Referees. (These may not be direct family members) Referee no. 1 Name Relationship Referee no. 2 Name Relationship Why are you considering a career in Cheffing / Hospitality Industry? Explain

5 Page 5 of 5 Required Enclosures These items should be included with this application: R400 Application fee Matric Certificate / Recent School Results Curriculum Vitae Other / Higher Qualifications Reference Letter 1 Reference Letter 2 Certified Copy of ID Book 1 x Colour Passport Size Photograph Applicant s Full Names Applicant s Signature Date It is understood that any false or misleading information provided on this application form shall be considered sufficient cause for the disqualification of this applicant. IC A Banking Details Bank Branch Name Nedbank Business Southern Penins ula Branch Code Account No Bank Swift Code Reference NEDSZAJJ Student name and surname

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