SHORT COURSE(S) ENROLEMENT Please enable JavaScript in your browser to complete this form.Name: *FirstLast Initials: *Gender: *-Select-MaleFemaleTitle: *-Select-MrMrsMsMissMarital Status: *-Select-SingleMarriedDivorcedSeparatedWidowedID/Passport Number: *Citizenship: *Employment: *EmployedUnemployedVolunteerEthnic Group: *BlackColouredWhiteIndianOtherMother Tongue: *-Select-AfrikaansEnglishNdebeleXhosaZuluPediTsongaTswanaSothoVendaSwatiOtherTel (H): *Cell Number: *Tel (W): *Fax: *Email: *Next Of Kin : *FirstLastTel (H): *Tel (W): *Email: *Physical Address: *Postal Address: *Disabilities: *HearingPhysicalSightSpeechOtherNoneComputer Literacy: *IlliterateFairly LiterateHighly LiterateShort Course Qualification(s): *Skills Program in Basic life support and First Aid proceduresHIV and AIDS workplace management skills programmeSkills program in HIV and AIDS peer educationSkills program in substance abuse and addiction managementOccupational Health and Safety in workplace skills programHIV counselling and testing programWellness Champion’s programWorkplace Skills programSkill program in rehabilitation for terminally ill patientsSkills program in HIV/AIDS educationStrategic interventions in victim empowermentThogomelo Child ProtectionThogomelo Psychosocial SupportThogomelo Supportive SupervisionDo You Need Academic Support? *-Select-NoYes2.Family Doctor:Tel:Address:Submit
