UNIVERSITY OF PRETORIA

FACULTY OF HEALTH SCIENCES

APPLICATION FOR SELECTION TO CONTINUE POST GRADUATE STUDIES

AS A REGISTERED STUDENT

Year of intended study

PLEASE HAND IN YOUR APPLICATION AT THE RELEVANT DEPARTMENT

Student number
Surname

Full name

ID number

Permanent
postal address

Code

Telephone

Cell phone

E-mail

Pre-graduate
study course

Post-graduate
study course

Signature
Date

OFFICIAL USE ONLY

Recommended
Date

HEAD OF DEPARTMENT
Approved
Date

DEAN
Conditions:
Curriculum Vitae, Written declaration of intention, Motivation/support from employer
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