Enrolment form

ENROLLMENT FORM

TEACHING DEVELOPMENT PROGRAMME 2012

APPLICANT		HEAD OF DEPARTMENT/SUPERVISOR’S RECOMMENDATION & APPROVAL
Surname		I recommend that the applicant be accepted on the TDP/HDHET; the applicant is able to attend TDP/HDHET sessions (Wed 2-4 pm)
First name		Surname
Dept/Faculty		Name
Tel no.		Faculty/Dept
E-mail		Designation
Job Title		Signature*
Personnel No.		Date
Name to appear on certificate
Applicant’s Signature*
PLEASE SEND THIS FORM TO:		FOR OFFICE USE ONLY:
Dr. Lorraine Hassan hassanl@cput.ac.za Tel: 021-4603536 Fax: 021-4603711		Application received:
		Attachment qualification(s)
CONDITIONS Ø  Forms must be completed  in full and signed by the applicant and his/her Head of Department or supervisor Ø  All applicants must be in possession of an undergraduate qualification (eg B Tech) (please attach photocopy of all qualifications) Ø  All applicants must be full-time or part-time academic staff members, and should currently be teaching at higher education undergraduate or postgraduate levels Ø  All applicants must be able to attend Wednesday afternoon (14h00-16h00) coursework sessions.

*Electronic signatures will be accepted