Learner Profile collection form Center * PERSONAL INFORMATION – Learner’s personal details Name * Name First Name as per ID First Name as per ID Surname Surname Preferred Name South African ID Number * Date of Birth * Gender * –Select–MaleFemalePrefer not to say Nationality / Citizenship –Select–South African CitizenPermanent ResidentOther Race / Population Group –Select–African BlackWhiteIndianColoured Home Language –Select language–SesothoSepediSetswanaZuluXhosaEnglishAfrikaansVendaNdebeleTsongaSiswati Disability Status –Select–No DisabilityPhysical DisabilityHearing impairmentVisual impairmentOther CONTACT DETAILS – Learner and guardian Learner’s contact information Learner’s Cell Number Learner’s Cell (WhatsApp) Learner’s Email Address Address 1 (Learner) Address 2 (Learner) Province (Learner) –Select–GautengMpumalangaLimpopoNorth WestFree StateKwa-Zulu NatalEastern CapeWestern CapeNorthern Cape Area Code (Learner) Parent/ Guadians’s contact information Parent / Guardian Full Name * Parent / Guardian Full Name First Name First Name Last Name Last Name Relationship to Learner –Select–MotherFatherGrandparentGuardianOther Guardian’s ID Number Guardian’s Cell Number Guardian’s Cell (WhatsApp) Guardian Email Address Address 1 (Parent) Address 2 (Parent) Province (Parent) Eastern CapeFree StateGautengKznLimpopoMpumalangaNorth WestNorthern CapeuncategorizedWestern Cape Area Code (Parent) Parent/ Guardian’s employment status * –Select–Formally employedSelf-employedUnemployedSASSA Grant RecipientsRetired / PensionDeceased (orphan) SCHOOL INFORMATION – Current and previous schooling Current School Name School Type SELECTPublic SchoolPrivate/ Independent SchoolModel C SchoolTertiaryOther School Type Province Eastern CapeFree StateGautengKznLimpopoMpumalangaNorth WestNorthern CapeuncategorizedWestern Cape Dristrict Current Grade/ Status –Select–Grade 11Grade 12Completed Matric Matric Year GRADE 11 RESULTS (Gr 12 results for post matriculants) Results STUDY INTENTIONS Type of Institutions Applying to: University University of technology Tvet College Private College Online Study Institutions Companies Training Programs Field of study / Career Interest Here are some examples of Fields of Study / Career Interests that students can choose from when exploring tertiary education and future careers: Science & Health * Medicine* Nursing* Pharmacy* Radiography* Physiotherapy* Psychology* Biotechnology Engineering & Technical Mechanical Engineering* Electrical Engineering* Civil Engineering* Chemical Engineering* Mining Engineering* Automotive Engineering Business & Commerce * Accounting* Business Management* Marketing* Human Resource Management* Entrepreneurship* Economics Information Technology & Computing * Computer Science* Information Technology* Cybersecurity* Data Science* Software Engineering Education & Social Services * Education* Social Work* Counselling* Early Childhood Development Agriculture & Environmental Studies * Agricultural Science* Environmental Science* Forestry* Animal Science Creative Arts & Media * Graphic Design* Journalism* Fashion Design* Film Production* Music Law, Safety & Public Services * Law* Criminology* Policing* Occupational Health and Safety* Military Science Hospitality, Tourism & Services * Hospitality Management* Tourism Management* Culinary Arts* Event Management Students can use these examples to identify: * Subjects they enjoy * Careers they are curious about * Qualification type (Degree, Diploma, Certificate) * Workplace Training * Institutions that offer those programs 1st Choice Institution 2nd Choice Institution 3rd Choice Institution Preferred Province Preferred Institution of study Preferred Qualification Submit If you are human, leave this field blank.