PERSONAL DETAILS
STUDENT AGREEMENT
Please write neatly and complete all sections
Name ________________________________________
Surname _______________________________________
Mr/Mrs/Ms _______________Initials ________________
ID Number _____________________________________
Date of Birth ____________________________________ the Promisions of Section 65J of the Magistrates Court Act
Cell No. _______________________________________
Home Tel No. ___________________________________
Work Tel No. ___________________________________
Email Address __________________________________
Postal Address (address where material will be posted to)
_______________________________________________
_______________________________________________
_______________________________________________
Home Address __________________________________
_______________________________________________
Work Address ___________________________________
_______________________________________________
Your Job Title ___________________________________
Name of Supervisor _____________________________
Highest Grade Passed _____________
Next of Kin Name _______________________________
Next of Kin Tel No. (H)____________ (W)____________
Contact details of relative or friend NOT living with you:
Name _____________________________
Address ____________________________
___________________________________
Tel No: (H) ____________________
(W) ____________________
1. I am aware that any bursary offered to me by
Academy of York is only credited to my account
The The
when I have fulfilled my payment obligations to them.
Academy Academy
2. I declare, that after entering this agreement, I still have OF OF
york
sufficient means to support myself.
3. In the event that I am in arrears, or if legal action is instituted, I York
agree to pay all legal costs, including legal charges, collection
charges, tracking costs and commissions. I consent in Terms of
No.32 of 1944 to an emoluments attachment order to be issued,
ACADEMY OF YORK
without further notice to me, from the Court of the District in
which my employer resides, carries on business, or is employed,
and that the amounts of the emoluments be attached in
installments as reflected in my agreement with Academy of York.
REGISTRATION DOCUMENT
4. Should I fail to make any payment owing, any Bursary may
be withdrawn and the full amount of the balance owing shall
become immediately payable. Academy of York shall be entitled l NO TESTS AND EXAMS
to proceed against me for recovery without further notice. l Only Assignments
5. In the case where I am in arrears, or if legal action is instated,
I agree to pay all legal costs, including legal charges as between
l Study from home
attorney and client.
6. I agree that the Post Office shall be my agent for the 60% Part Bursary
acceptance and conveyance of all study material or awarded. You only
correspondence addressed to me.
7. I will adhere to the cancellation policy of the Academy of York
pay for 40% of
8. I declare that all particulars provided by me on this form the course.
are true and correct.
9. I understand that Academy of York offer comprehensive
job-orientated skills programmes
10. I understand that by signing below and by acceptance by Academy for 2010
of York of the offer contained herein, an irrevocable agreement Enrol now rices!
p
shall be constituted between myself and Academy of York subject at 2009’s
to the conditions contained in this form, and I undertake herewith
to pay Academy of York in the manner set out in this form.
11. Academy of York may cede this agreement.
12. I choose my home address as set out in this form as my
domicilium citandi et executandi. CONTACT DETAILS
13. Academy of York guarantees to provide tuition for twelve
months from the date of registration.
Phone: 086 123 YORK (086 123 9675)
Signed at (town) __________________________________ E-mail: info@aoy.co.za Website: www.aoy.co.za
Postal: P O Box 12831,
on (Date) _______________________________________ Queenswood, 0121
PLEASE
SIGN HERE _____________________________ X ENROL NOW: Complete this form, fax it to
086 523 8077, pay your registration fee, and
Signature of Parent _______________________________ receive your FREE Study Guide.
or Guardian (if applicable)
 PROGRAMME DETAIL PAYMENT REQUIREMENTS Payment and
(ONLY FOR BURSARY CANDIDATES) Courier Details
The schedule below takes into account that OPTION 1: ONE PAYMENT
PROGRAMME TITLE: ____________________________ you were awarded a 60% Part Bursary. The part
I enclose payment of R ________
bursary is credited to your account when you
have fulfilled your payment obligations. By Cheque
PROGRAMME CODE:
(Obtainable from Course List) FULL REGISTRATION INSTALLMENTS ONE Deposit Slip as proof of Bank Payment
PROGRAMME FEE PLUS OR PAYMENT
PROGRAMME LEVEL PROGRAMME FEES FEES
OR
MARK FULL 60% YOU CERTIFICATE
R 395 + R 200 pm x 13.5 OPTION 2: MONTHLY INSTALLMENTS
ONE PROGRAMME PART ONLY or
(X) FEES BURSARY PAY R 300 pm x 9.2 OR R 1 895 I enclose my registration fee of R395
or
BASIC R 400 pm x 6.9
R 6 875 R 4 125 R 2 750
CERTIFICATE I will make further payments of: (Select one)
MASTERY R 395 + R 200 pm x 18.8
CERTIFICATE or
MASTERY R 9 375 R 5 625 R 3 750 R 300 pm x 12.5 OR R 2 895 R200 or R300 or R400
CERTIFICATE
or
R 400 pm x 9.4
CADEMY OF YORK
A R 11 875 R 7 125 R 4 750 by the last day of each month following my
DIPLOMA / SKILLS ACADEMY R 395 + R 200 pm x 23.8 registration until my full account has been settled.
PROGRAMME OF YORK or

DIPLOMA / R 300 pm x 15.8 OR R 3 895 OR

SKILLS or
PROGRAMME R 400 pm x 11.9 OPTION 3: STOP ORDER
REGISTRATION FEE (NON REFUNDABLE) If you have a savings or cheque account and wish to
When you return this form you MUST enclose your The One Payment option includes the Registration pay by stop order, please mark the boxes below and
registration fee of R395 unless you are using the one Fee and Insured Parcel Post for your course Manuals, we will send you the necessary instructions.
payment option to pay in full. You only have to register Material and Assignments.
once, after registration you can study any amount of PLEASE NOTE: If you choose this payment option
programmes. If paying by installments registration fee of R395 MUST you must first pay your registration fee of R395
be paid with your application, either by cheque or direct by Cheque, or bank deposit, otherwise we will be
If you make a direct bank deposit, please send / fax bank transfer (in which case a copy MUST be sent back unable to register you.
the deposit slip back to us. PLEASE USE INITIALS with this form). PLEASE USE INITIALS AND SURNAME
AND SURNAME AS REFERENCE. If you do not do AS REFERENCE. I enclose my Registration Fee of R395
this, we will NOT be able to register you.
BANK DETAILS BANK : ABSA Please send me stop order details
ACCOUNT NAME : Academy of York
I enclose R300 (Excluding Registration Fee)
QUALIFICATIONS ACCOUNT NUMBER : 4069 897 949
Please courier my documents to me.
Your Academy of York Diploma or Skills Programme BRANCH CODE : 632 005
Certificate will be issued to you once you I hereby agree to the above Payment options Terms
have successfully completed the IMPORTANT NOTICE:
and Conditions.
above selected course and The Registration fee of R395 MUST be paid, and proof
course level, and once all of payment MUST accompany this form back to us.
PLEASE
SIGN __________________________
HERE X
payment have been received. Otherwise we can NOT register you.

Please ensure you sign the chosen payment option. Date: ____________________________________