MINISTRY OF EDUCATION

FORM 4 REPUBLIC OF NAMIBA MINISTRY OF EDUCATION EDUCATION ACT 2001 APPLICATION FOR REGISTRATION OF A PRIVATE SCHOOL SECTION A (INFORMATION ABOUT SCHOOL AND OWNER OR CONTROLLING BODY) A1. Name of the private school A2. Starting date of school.. A3. How will school function: As a normal school for full-time candidates using face-to-face methods? As an institution for part-time candidates using distance education methods? Other:..... A4. Postal Address A5. Will this be the only site of the private school or will there be satellite schools at other places? A6. Educational region and magisterial district in which school is situated..... A7. Full name, address and contact details of the legal owner of the private school Name. Address.. Contact details Tel code.. no.. Fax code. no.. Email Cell

2 A8. Full name, address and contact details of the applicant if the applicant is not the owner Name.. Address. Contact details Tel code no. Fax code.. no. Email Cell A9. Capacity of applicant (e.g. owner: board member, etc).. A10. Names and addresses of any other educational institutions or schools, and their current status, operated by or that were operated by, the same owner or controlling body of which the owner was a member. A.11 Competence and experience of owner or controlling body of school A11.1 Owner of school QUALIFICATIONS* EXPERIENCE IN EDUCATION OTHER RELEVANT EXPERIENCE (*Certified copies of qualifications must be attached to application form.) A11.2 Members of controlling body (if established) NAME QUALIFICATIONS ADDRESS RELEVANT EXPERIENCE 1. 2. 3. 4. 5.

3 A12. Is the private school registered as a Namibian taxpayer? Yes No If yes, provide the name and address under which the school is registered and the tax reference number of the school. Registered name as taxpayer: Tax reference number:.. SECTION B (APPLICATION FOR A PRIVATE TUITION CENTRE) B1. Details of curriculum teaching and learning materials and extra curricular activities B1.1 Pre-Primary Yes No Government Curriculum Yes No If a curriculum is different from that applicable to state schools should be followed please see paragraph B3. If a government curriculum will be followed provide details of the teaching and learning materials the school will use to deliver the curriculum.. Duration of pre-primary phase: Years B1.2 Junior Primary Yes No (Grades 1 3) Government Curriculum Yes No If a curriculum is different from that applicable to state schools should be followed please see paragraph B3. For a government curriculum provides details of the subjects that will be offered. SUBJECTS GRADES

4 For a government curriculum attaches the list of the learning materials (textbooks, worksheets, writing pads, etc.) learners will need and a list of the teaching materials teachers will use. Will the school provide the learners and teachers with the abovementioned materials or must they buy their own materials?: Learners:. Teachers: Provide the extracurricular and extramural activities the school will provide to the junior primary learners. Duration of junior primary phase:.years B1.3 Senior Primary Yes No (Grades 4-7) Government Curriculum Yes No If a curriculum is different from that applicable to state schools should be followed please see paragraph B3. For a government curriculums provide details of the subjects that will be offered. EXAMINATIONS SUBJECTS NON-EXAMINATION SUBJECTS (Indicate with an asterisk the compulsory subjects.) For a government curriculum attaches the list of the learning materials per subject (textbooks, worksheets, writing pads. etc) which learners must have and a list of the teaching materials teachers must use. Will the school provide the learners and teachers with the above mentioned materials or must they buy their own materials? Learners:. Teachers:

5 Provide the extramural activities the school will offer in this school phase. Are you aware of the ministerial policies on assessment and will the school as minimum requirement implement these policies? Provide details. Duration of senior primary school phase: years B1.4 Junior Secondary Yes No (Grades 8 10) Government Curriculum Yes No If a curriculum is different from that applicable to state schools should be followed please see paragraph B3. For a government curriculum provides details of the subjects that will be offered. CORE SUBJECTS OPTIONAL AND NON EXAMINATION SUBJECTS How many subjects will a learner offer? Examination subjects. Non examination subjects.. For a government curriculum attach the list of the learning materials per subject (textbooks, worksheets, writing pads. etc.) learners will need and a list of the teaching materials teachers will use. Will the school provide the learners and teachers with the abovementioned materials or must they buy their own materials? Learners:. Teachers:

6 Provide details of the extracurricular and extramural activities the school will offer in this school phase... Are you aware of the ministerial policies on assessment and will the school as minimum requirement implement these policies? Provide details. Duration of junior secondary school phase:.years B 1.5 Senior Secondary Yes No (Grades 11 12) Government Curriculum Yes No If a curriculum is different from that applicable to state schools should be followed please see paragraph B3. For a government curriculum at which level will the NSSC subjects be offered? (tick as applicable) Ordinary Level Higher Level Combination of Ordinary and Higher Level List the Ordinary and Higher Level subjects that will be offered. ORDINARY LEVEL HIGHER LEVEL

7 For a government curriculum provide details of the languages, the field of study subjects and the optional subjects for each of the fields of study offered. Language subjects Field of Study Subjects Optional Subjects (one of the following) 1. 1. 2. 2. 3. 3. 1. 1. 2. 2. 3. 3. For a government curriculum attaches the list of the learning materials per subject (textbooks, worksheets, writing pads, etc) which learners must have and a list of the teaching materials teachers must use. Will the school provide the learners and teachers with the abovementioned materials or must they buy their own materials? Learners: Teachers:.. Provide details of the extracurricular activities the school will offer in this school phase. How many subjects will a learner offer? Examination subjects. Non Examination subject Duration of senior secondary school phase: years. Will the school accommodate learners with impairments?

8 If yes which impairments? Does the school have the facilities and resources, and the teachers with the qualifications and experience to implement the compulsory Course Work/School Based assessment specified in the following NSSC Ordinary and Higher Level syllabuses? NSSC ORDINARY LEVEL YES NO NSSC HIGHER LEVEL YES NO Agriculture Physical Science Home Economics Biology Fashion and Fabrics First Languages First Languages Second Languages Second Languages Design and Technology Design and Technology B2 Medium(s) of instruction and assessment Pre-Primary Junior Primary Senior Primary Junior Secondary.... Senior Secondary.. B3. *Please note, the application for approval of a curriculum, languages as medium of instruction, or examining body for a private school which is different from that applicable to state schools, as referred to in section 50 of Act No. 16 of 2001, the application must be accompanied by a) a full motivation and reasons for the use of a different medium of instruction, curriculum or examining body; b) a full broad curriculum document or documents, examples of subject syllabuses, principles of assessment and examples of subject textbooks, in the case of different curriculum; and c) the credentials of the examining body, proof of regional and international recognition of the certificates issued by the examining body, in the case of different examining body. (The documents must accompany the application)

9 B4. What school calendar will be followed for the school phase(s) offered? Calendar for government schools Yes No If the calendar for government schools will not be followed attach the calendar that will be followed. The calendar must be in the same format as the calendar for government schools. B5. For each school phase and the subjects offered attach a timetable for a week indicating the number of periods and the duration of the periods per day. B6. Daily starting time.and closing time.of the school. B7. Nearest school(s) offering education in the same school phases applied for in this application. SCHOOL PHASE NAME OF SCHOOL APPROXIMATE DISTANCE Pre-Primary Primary (Grade 1-7) Junior Secondary(Grades 8-10) Senior Secondary(Grades 11-12) B8 Attach to the application the prospectus of the school and the following information, as Separate attachments, if not included in the prospectus. A motivation letter for the establishment of the private school which provides information about the aspects mentioned in section 42(2) of Act No. 16 of 2001. The aims and objectives of the school.

10 Reasons for the establishment of the school. The admission policy of the school. B9. Fees payable annually learners (indicate as applicable) TYPE OF FEE AMOUNT PER ANNUM Registration or enrolment fee N$ Tuition N$ Hostel N$ Examination N$ School Development Fund N$ Fees for textbooks and other learning materials N$ Any other type of fee.. N$ N$ N$ Please note if there should be any change in the abovementioned fees the Ministry must be informed. B10. Enrolment figures and teacher learner ratio (as applicable per school phase) according to capacity and resources of the school. Pre-Primary Gr 0 Junior Primary Gr 1 Gr 2 Gr 3 Initial Numbers Ultimate Numbers Teacher: Learner ratio per phase Senior Primary Gr 4 Gr 5 Gr 6 Gr 7 Junior Secondary Gr 8 Gr 9 Gr 10 Senior Secondary Gr 11 Gr 12 Other (specify)

11 B11. Which school is the expected intake to this private school currently attending or where will they come from? B12. Which specific needs will this private school provide in which are not already provided for in government schools?.. B13. Ages of learners that will be enrolled. Minimum Age Maximum Age Pre-Primary Junior Primary Senior Primary Junior Secondary Senior Secondary Other (Specify) B14. Information about principal and teaching staff (Complete Annexure attached at the end of section B) (Please note an evaluation by the Namibia Qualifications Authority (NQA) of foreign qualifications must be attached to the abovementioned Annexure as well as a Work Permit for teachers who are foreign nationals). B15. Hostel accommodation Does the school provide hostel accommodation? Yes No If yes how many males.and females can be accommodated and what is the distance in kilometers between the school and hostel..km. B16. Buildings, furniture, equipment, etc. Provide the following information B16.1 Buildings Type Classrooms Principal s office Number in Existence Total size in Square meters In existence Number still To be constructed Total size in Square meters Not in existence Construction Material e.g bricks

12 Offices for Head of Department Office for School Secretary Staff room for Teachers Library Storeroom for School records Safe Facility for Confidential documents Laboratory for Natural Science Laboratory for Biology/Life Science Laboratory for Physical Science Other Specialist Rooms (Specify) Toilet Facilities for girls Toilet facilities for boys Toilet facilities for teachers Facilities for Physical Education(specify) Sport Facilities Any other facilities (specify)e.g -

13 B16.2 Furniture equipment and office stationery TYPE NUMBER AVAILABLE NUMBER STILL TO BE OBTAINED TOTAL REMARKS School tables for learners School chairs for learners Office tables for teachers Office chairs for teachers Cabinets for storing of documents First Aid Kits Telephones Fax Machines Typewriters PCs and printers Overhead projectors Chalk Boards Files Shelves Photo copiers Notice Boards Tape recorders CD-players Other (specify) - 16.3 Records and registers Type Enrolment register of learners Attendance register Pass records of learners Misconduct records Financial records Record of unsuccessful applications for admission Records of results of written admission or language tests Tape recording orally administered admission or language test Record of agendas and minutes of staff meetings Records/Registers in Place Records/registers still to be established Remarks

14 Record of agendas and minutes of meetings of controlling body Records of Examiners Reports of National examinations Record of Ministerial Circulars Record of schedules of marks of learners Record of school reports of learners Records of answer scripts ------------------------------------------------------------------------------------------------------------------------------------------- B16.4 Electricity and water Does the school have electricity? Yes No Does the school have clean water? Yes No - - B17 Financial provision Documentary proof that adequate financial provision is available to establish and maintain the school must be attached to the application form. Attach a statement with the estimated income and expenditure of the school for the first three (3) years. The expenditure statement must provide details of the expected expenses whilst the income statement must provide details of the sources of income of the school when in operation. - - B18. Are the learners expected to enter into an agreement with the school? Yes No - - SECTION C (APPLICATION FOR A PRIVATE EXAMINATION CENTRE) - C1 Information about the private examination centre Name of the examination centre (should be the same as for the tuition centre). Educational Region where the centre is located?... C2 Which of the national examinations will be offered? The Standardised Achievement Tests (SATs) Grade 5 and 7? The Junior Secondary Certificate Examination (JSC)? The Namibia Senior Secondary Certificate Ordinary Level (NSSC/O)? The Namibia Senior Secondary Certificate Higher Level (NSSC/H)?

15 Please note, if an examination different from the abovementioned is to be offered the school must apply with the Ministry of Education for approval in terms of Section 50 of Act No. 16 of 2001. C3 Date of first national examination. EXAMINATION JSC NSSC/O NSSC/H SATs (Grade 5) SATs (Grade 7) YEAR - - C4 Facilities to offer the National Examinations C4.1 What number of rooms/halls appropriate for the sitting of examinations are available at the school? Halls Rooms C4.2 Do the rooms/halls have tables, chairs and sufficient lighting, ventilation, a low noise level, and do conditions conducive for candidates to perform optimally prevail? Yes No - C4.3 Will the space, furniture, number of invigilators etc. be sufficient to simultaneously accommodate the candidates sitting their national examinations and for the learners in the intermediate grades to continue with their classes (or writer their internal examinations)? Yes No - C4.4 Will the centre be able to accommodate Grade 10 and 12 part-time candidates for the national examinations? Yes No C4.5 If the required spacing of 1.25 meters in any direction between each candidate s position and that of the nearest candidates is complied with, what number of candidates sitting each of the following examinations can be accommodated at the same time at the school? - EXAMINATION FULL-TIME CANDS PART-TIME CANDS N/A End of Grade 10 JSC examination End of Grade 12 NSSC/O examination End of Grade 12 NSSC/H examination SATs Grade 5 & 7

16 C5. Secure Storage of Examination Materials C5.1 Does the school have safe facilities big enough to securely store all the examination material of both the nation examinations (question papers, answer books, answer scripts, OMR Forms, etc.) and the examination material of the internal examinations? Yes No What are the internal dimensions of the safe/safe facilities: length.metres Height metres Width metres C5.2 Which one of the following describe the safe facilities best? a) A strong room with lockable safe door b) A store room with lockable burglar barred door and windows c) A store room with lockable burglar barred door and windows with a lockable steel cabinet for the examination materials. d) A steel cabinet in the principal s office which has a lockable burglar barred door and burglar barred windows. e) A heavy free standing steel safe in the principal s office. f) If not any of the above mentioned, describe the type of safe facilities available... g) How many keys for the safe/safe facilities are in use at the centre? Will the centre make a space key available to the Regional Office? h) Has a key register been opened and who is in control of the register?.. i) Are duplicate keys for the safe/safe facilities available and where are they kept?. j) Will other materials be stored in the safe/safe facilities together with the examination materials?. C6 Who will be the Head of the Examination Centre responsible for the overall control and secure and proper administration of the national examinations (e.g. security: safekeeping of examination materials; registration of candidates; handling of collected state monies; receipt and dispatch of examination materials; etc.) Name: Years experience (As teacher): As principal: HOD; etc.) Qualifications: -

17 C7. Has the Head of Centre been trained by the Directorate National Examinations and Assessment or the Regional Office in the principles and procedures of examination s administration and invigilation? If yes when was the training done?...... C8. Were the teachers who will invigilate the national examinations trained by the Directorate National Examinations and Assessment or the Regional Office in the principles and procedures of invigilation? If yes when was the training done?.. C9. Are the Head of Centre and teachers aware that they could, in terms of Education Act No. 16 of 2001, be charged with misconduct, or for a criminal offence, if the Examination Rules and Treasury Instructions are not adhered to, and that the results of candidates can be declared null and void if they are involved in malpractices? - C10. Collection of examination registration fees and other examination related monies C10.1 Is the centre registered as a sub-receiver of revenue or cashier s office to collect state monies and issue receipts?... C10.2 Is the school in possession of a copy of the Treasury Instructions?.. C10.3 Is the school in possession of a Receipt Book/ Credit Note Book? C10.4 Is the school in possession of the Rules and Regulations for the administration of the national examinations?. - C11 Capacity and resources to administer school based assessments C11.1 NSSC Examinations Indicate the availability of the following: a) Laboratory to administer the practical examination in Physical Science. Yes No b) Laboratory to administer the practical examination in Biology. Yes No

18 c) Cassette or CD-players to administer the Listening Comprehension tests in the second and foreign languages. Yes No d) Cassette or CD recorders to record the oral components of the first, Second and foreign languages. Yes No e) Facilities, equipment and materials for the practical tests and to do the School based assessment tasks in Home Economics. Yes No f) Facilities, equipment and materials to do the school based assessment tasks in Fashion and Fabrics. Yes No g) Facilities, equipment and materials to do the school based assessment tasks in Agriculture. Yes No h) Facilities, equipment and materials to do the Coursework in Art and Design. Yes No i) Facilities equipment and materials to do the Coursework in Design and Technology. Yes No j) Experienced and qualified teachers to internally asses, the speaking/ oral components and mark the Literature assignments of the European Languages? Yes No k) Experienced and qualified teachers to internally assess, the speaking/ oral components and mark the literature components of the Namibian/African Languages. Yes No l) Experienced and qualified teachers to internally moderate the marked Literature components of the European Languages? Yes No m) Experienced and qualified teachers to internally moderate the marked Literature components of the Namibian/African Languages. Yes No n) Equipment and materials to administer the national examinations to impaired candidates (E.g. Typing to blind candidates) Yes No ---- -- C11.2 JSC Examinations Indicate the availability of the following; a) Cassette or CD players to administer the Listening Comprehension tests in the languages. Yes No b) Facilities, equipment and materials to do the school based assessment tasks in the subjects that will be offered by the centre. Yes No c) Experienced and qualified teachers to internally moderate the marked school based assessment tasks before the marks are forwarded to the DNEA. Yes No d) Equipment and materials to administer the national examinations to impaired candidates (E.g. Typing to blind candidates) Yes No

19 SECTION D (TO BE COMPLETED BY THE OWNER OF THE PRIVATE SCHOOL) -- - D1. I herewith apply for the registration of a private school with tuition and examination centre status/ or tuition centre status only (delete as applicable). I further state that the information provided is accurate and true reflection of the situation and circumstances at the school and I understand the terms and conditions of registration specified in Education Act No. 16 of 2001 and the Regulations made under the said act. I undertake in terms of Section 57 (d) in Regulation No. 187 not to deviate from the approved curriculum without the approval of the Minister. D2. Is this the first application to register this school as a private school? Yes No If no, when was the first or earlier applications submitted?...... OWNER OF PRIVATE SCHOOL SIGNATURE DATE.... WITNESS SIGNATURE DATE

20 SECTION E (TO BE COMPLETED BY THE INSPECTION TEAM AT THE REGIONAL OFFICE) ------------------------ - E1. Verification of the information provided by the private school E1.1 The school was visited by an inspection team of the regional office. NAME POSITION DATE Inspector of Education Education Officer: Planning and Development Regional Examination Official (REXO) Other: ------------------------ - E1.2 The information provided on the application form was verified with the owner/ body of Directors of the private school by the inspection team. Yes No Comments:..... -------------------- - E1.3 Were discrepancies found between the information provided in the application and the situation found at the school? Yes No -------------------- E1.4 If discrepancies were found, provided the details.... -------------------- - E2 Evaluation of Information by Inspection Team E2.1 Is there according to the judgment of the inspection team a need for this private school in the region?...... E2.2 Specific need(s) this school will provide in?.. ------------------- E2.3 How permanent are these needs?

21 -- --------------------- E2.4 The judgement of the inspection team after having considered the terms and conditions in Act No. 16 of 2001, and The Regulations made under the said Act, is that the school (Tick appropriate box) Meets the terms and conditions to be registered as a private school with tuition and examination centre status. Only meets the terms and conditions to be registered as a tuition centre But not as an examination centre. Does not meet the terms and conditions to be registered as either a tuition Or an examination centre and must re-apply when the shortcomings have been Rectified. Comments (if any).... SECTION F RECOMMENDATION BY THE REGIONAL DIRECTOR.................. NAME SIGNATURE DATE ------------------------ ---- SECTION G RECOMMENDATION OF THE COMMITTEE, EVALUATING THE APPLICATIONS OF PRIVATE SCHOOLS, TO THE NATIONAL EXAMINATION, ASSESSMENT AND CERTIFICATION BOARD......... CHAIRPERSON OF COMMITTEE SIGNATURE DATE