Please Indicate Campus Of Choice
NELSON MANDELA BUFFALO CITY
BUTTERWORTH QUEENSTOWN
Applicant Particulars
Surname Name
Student Number Title
Gender Date Of Birth
Contact Telephone Home Cell
Email    
Postal Address  
   
 
Code
Phsical Residential Address(Home)  
   
 
Code

 

Gurdian Or Parents Particulars
Surname Name
Gender Title
Contact Telephone Home Cell
Email    
Postal Address  
   
 
Code
Phsical Residential Address(Home)  
   
 
Code

 

Academic Information
Proposed Caurse Of Study

 

Current Registered Subjects
SUBJECT YEAR/SEMESTER SUBJECT YEAR/SEMESTER
1. 2.
3. 4.
5. 6.
7. 8
9. 10.
       

 

Historical Background
  • Have you previously beeen admited to residence at this University
  • If so,give name of residence and year of admission
  • Have you you ever been refused admission to an adcademic residence bofore?
  • If so,give name of School/University/College

 

 

State Of Health
General state of health
Particulars of physical disability,if any(very important for room allocation)

 

Declaration by applicant

I declare that the information given in this application form is correct and that any incorrect information given here could lead to withdrawall of an offer to accommodation,expulsion from WSU residence,or disciplinary action.I also declarer that i will abide by all rules and regulations of Walter Sisulu University,should i be admitted to WSU residences both instistutional and private accommodation.

Signature of Applicant...........
Date..............