Enrol at Excel Edu Centre - Excel Edu Centre

Grade applied for

Highest grade passed

First Name

Last Name

Gender

Male

Female

Others

Nationality and Race

Date of Birth

ID number

Home Language

Religion

Number of Siblings

Position

Name and Area

Telephone Number

Has the learner failed a grade before, if so, which grade/s

Medical Aid

Medical Aid Number

Name of Principal Member (Medical Aid)

Learners Allergies/Chronic Illeness / Disabilities

Learners Dexterity

Doctors Name and Contact Number

Proof of identity (e.g. birth certificate, Passport etc.)

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High School Name

GPA

Diploma Type

High School Transcripts

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Medical Allergies

Parent/Guardian (First Name)

(Last Name)

Parent/Guardian Company

Parent/Guardian Phone

Parent/Guardian Email