postgraduate registration form 20 - imm
POSTGRADUATE REGISTRATION FORM 20
PG
STUDENT NUMBER (New students to leave blank)
Semester 1
Semester 2
PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THIS FORM (IN BLOCK LETTERS USING A BLACK PEN). 1. 2. 3. 4. 5. 6.
This Postgraduate Registration Form must only be completed once the student has been accepted to study towards the relevant programme. This Postgraduate Registration Form must only be completed by students who are studying towards the following programmes: a. Postgraduate Diploma in Marketing Management b. BPhil Honours in Marketing Management Postgraduate Diploma and BPhil students must complete all sections. Read the Student Yearbook as well as the Prospectus carefully before completing and submitting this Postgraduate Registration Form with all the relevant information. This Postgraduate Registration Form may not be faxed or emailed to the IMM Graduate School of Marketing (IMM GSM). The IMM GSM cannot accept / process incomplete Postgraduate Registration Forms, even if full payment has been received. The onus is upon the student to provide all outstanding information / documentation in order for the IMM GSM to process the Postgraduate Registration Form. 7. Late fees will apply when the Postgraduate Registration Form is received after the due date, even if the payment was received by the due date.
THE FOLLOWING DOCUMENT MUST BE ATTACHED TO THE REGISTRATION FORM:
Examination Declaration
Do you want to receive confidential information e.g. academic results via sms? Choose the communication channel for receiving general notifications:
Sms
Yes
No
Email
Both
SECTION A: PERSONAL DETAILS (COMPULSORY) TITLE
GENDER Male Female
Prof Dr Mr Mrs Ms Miss Other
SURNAME As per ID Document / Passport
PREFERRED NAME
FIRST NAME(S) As per ID Document / Passport ID / PASSPORT NO
DATE OF BIRTH
D
D
M
M
Y
Y
Y
Y
LEGISLATION REQUIREMENTS (foreign students only) If you are not a South African citizen and you are writing examinations in South Africa, please state the following PERMIT NUMBER
PERMIT EXPIRY DATE
/
/ 20
(If the permit originally submitted has expired, please submit a certified copy of the new permit)
CONTACT DETAILS (new students only, OR complete only if details have changed) TELEPHONE NO. WORK (
)
HOME (
)
CELL PHONE
FAX (
)
EMAIL PREFERRED METHOD OF URGENT NOTIFICATIONS SMS
Email
ADDRESS DETAILS (New students only, OR complete only if details have changed) POSTAL ADDRESS
POSTAL CODE
WORK DETAILS (new students only, OR complete only if details have changed) OCCUPATION
NAME OF EMPLOYER
IMM GSM POSTGRADUATE REGISTRATION FORM P1
STUDENT NUMBER (New students to leave blank)
SECTION B: PAYMENT DETAILS NOTE
IMM GSM BANK DETAILS
NO CASH PAYMENTS ARE ACCEPTED AT ANY IMM GSM OFFICE. The following proof of payment / documentation has been attached to this registration form.
Bank Guaranteed Cheque
Direct Deposit
Credit / Debit Card
EFT / e-payment
Credit on account: R
ACCOUNT NAME: IMM Graduate School of Marketing (PTY) Ltd BANK: ABSA BRANCH: 160 JAN SMUTS AVENUE BRANCH CODE: 508 - 005 EFT CODE: 632005 ACCOUNT NUMBER 405 631 0798 Indicate your full name and surname or your IMM GSM student number as reference
,
SECTION C: ACADEMIC PROGRAMME DETAILS Please tick the programme for which you wish to register.
Postgraduate Diploma in Marketing Management
Other
BPhil Honours in Marketing Management
Single Module Entry
SECTION D: ASSESSMENT DETAILS (M Phil students must not complete this section) A maximum of four modules may be examined in one examination session. The IMM GSM however recommends that only two modules are examined per semester. MODULE
PRIVATE STUDENT OR (Please tick)
STUDENT SUPPORT CENTRE / COLLEGE (State Name and Branch)
FULL-TIME OR PART-TIME
1
PVT
FT
PT
2
PVT
FT
PT
3
PVT
FT
PT
4
PVT
FT
PT
SECTION E: EXAMINATION VENUE DETAILS Please tick the venue most suited to you: SOUTH AFRICA
Bloemfontein
Cape Town
Durban
Johannesburg Central* Midrand*
Pietermaritzburg
Polokwane
Port Elizabeth
Pretoria
Nelspruit
Stellenbosch
*The IMM GSM reserves the right to only use one of the venues in the Greater Johannesburg Metropole, or to allocate certain students to a specific venue due to venue capacity.
BOTSWANA
NAMIBIA
UNITED KINGDOM
ZIMBABWE
Gaborone Windhoek London Bulawayo Private Invigilation (Complete the Private Invigilation Application form)
Harare
OTHER Namely:
PLEASE NOTE: EXAMINATION VENUES CANNOT BE CHANGED AFTER 1ST APRIL IN SEMESTER ONE OR AFTER 1ST SEPTEMBER IN SEMESTER TWO.
SECTION F: STUDENT DECLARATION • I
have read the IMM GSM Prospectus and Student Yearbook. understand and accept all policies and procedures pertaining to the IMM GSM, including the IMM GSM’s examination policy, and agree to abide by the rules stated therein. • I understand and accept that upon my acceptance to the IMM GSM, I immediately become liable to the IMM GSM for the full programme fees and therefore undertake to pay the full programme fees on or before the due dates. • I understand and accept that should I withdraw from the programme at any time, I will give written notice of my intention and immediately pay all monies owing. • I
IMPORTANT: I understand and accept that for each semester a separate Postgraduate Registration Form must be completed and that no faxed or emailed Postgraduate Registration Forms will be accepted by the IMM GSM. STUDENT SIGNATURE
DATE
/
/ 20
National Office: Johannesburg Atlas Studio, 33 Frost Avenue, Braamfontein Werf, P O Box 91820, Auckland Park, 2006, Tel +27 (0)11 628 2000, Fax +27 (0)11 726 4505, Email [email protected] Durban Suite 9, The Lodge, Strathmore Park, 305 Musgrave Road, Berea, P O Box 35263, Northway, 4065, Tel +27 (0)31 202 5791, Fax +27 (0)31 202 5797, Email [email protected] Cape Town The Athenaeum Campus, Boundary Terrace, 1 Mariendahl Lane, Newlands, 7700, P O Box 23998, Claremont, 7735, Tel +27 (0)21 671 4426, Fax +27 (0)21 671 4424, Email [email protected] Zimbabwe Suite N & P, Sam Levy’s Village, Borrowdale, Harare, P O Box MP 394, Mount Pleasant, Harare, Tel +263 (4) 853 177, Fax +263 (4) 853 172, Email [email protected] The IMM Graduate School of Marketing (IMM GSM) is registered with the Department of Higher Education and Training (DHET) as a private higher education institution under the Higher Education Act, 1997. Registration certificate number 2000/HE07/013.
IMM GSM POSTGRADUATE REGISTRATION FORM P2
PG
STUDENT NUMBER (New students to leave blank)
Semester 1
Semester 2
PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THIS FORM (IN BLOCK LETTERS USING A BLACK PEN). 1. 2. 3. 4. 5. 6.
This Postgraduate Registration Form must only be completed once the student has been accepted to study towards the relevant programme. This Postgraduate Registration Form must only be completed by students who are studying towards the following programmes: a. Postgraduate Diploma in Marketing Management b. BPhil Honours in Marketing Management Postgraduate Diploma and BPhil students must complete all sections. Read the Student Yearbook as well as the Prospectus carefully before completing and submitting this Postgraduate Registration Form with all the relevant information. This Postgraduate Registration Form may not be faxed or emailed to the IMM Graduate School of Marketing (IMM GSM). The IMM GSM cannot accept / process incomplete Postgraduate Registration Forms, even if full payment has been received. The onus is upon the student to provide all outstanding information / documentation in order for the IMM GSM to process the Postgraduate Registration Form. 7. Late fees will apply when the Postgraduate Registration Form is received after the due date, even if the payment was received by the due date.
THE FOLLOWING DOCUMENT MUST BE ATTACHED TO THE REGISTRATION FORM:
Examination Declaration
Do you want to receive confidential information e.g. academic results via sms? Choose the communication channel for receiving general notifications:
Sms
Yes
No
Both
SECTION A: PERSONAL DETAILS (COMPULSORY) TITLE
GENDER Male Female
Prof Dr Mr Mrs Ms Miss Other
SURNAME As per ID Document / Passport
PREFERRED NAME
FIRST NAME(S) As per ID Document / Passport ID / PASSPORT NO
DATE OF BIRTH
D
D
M
M
Y
Y
Y
Y
LEGISLATION REQUIREMENTS (foreign students only) If you are not a South African citizen and you are writing examinations in South Africa, please state the following PERMIT NUMBER
PERMIT EXPIRY DATE
/
/ 20
(If the permit originally submitted has expired, please submit a certified copy of the new permit)
CONTACT DETAILS (new students only, OR complete only if details have changed) TELEPHONE NO. WORK (
)
HOME (
)
CELL PHONE
FAX (
)
EMAIL PREFERRED METHOD OF URGENT NOTIFICATIONS SMS
ADDRESS DETAILS (New students only, OR complete only if details have changed) POSTAL ADDRESS
POSTAL CODE
WORK DETAILS (new students only, OR complete only if details have changed) OCCUPATION
NAME OF EMPLOYER
IMM GSM POSTGRADUATE REGISTRATION FORM P1
STUDENT NUMBER (New students to leave blank)
SECTION B: PAYMENT DETAILS NOTE
IMM GSM BANK DETAILS
NO CASH PAYMENTS ARE ACCEPTED AT ANY IMM GSM OFFICE. The following proof of payment / documentation has been attached to this registration form.
Bank Guaranteed Cheque
Direct Deposit
Credit / Debit Card
EFT / e-payment
Credit on account: R
ACCOUNT NAME: IMM Graduate School of Marketing (PTY) Ltd BANK: ABSA BRANCH: 160 JAN SMUTS AVENUE BRANCH CODE: 508 - 005 EFT CODE: 632005 ACCOUNT NUMBER 405 631 0798 Indicate your full name and surname or your IMM GSM student number as reference
,
SECTION C: ACADEMIC PROGRAMME DETAILS Please tick the programme for which you wish to register.
Postgraduate Diploma in Marketing Management
Other
BPhil Honours in Marketing Management
Single Module Entry
SECTION D: ASSESSMENT DETAILS (M Phil students must not complete this section) A maximum of four modules may be examined in one examination session. The IMM GSM however recommends that only two modules are examined per semester. MODULE
PRIVATE STUDENT OR (Please tick)
STUDENT SUPPORT CENTRE / COLLEGE (State Name and Branch)
FULL-TIME OR PART-TIME
1
PVT
FT
PT
2
PVT
FT
PT
3
PVT
FT
PT
4
PVT
FT
PT
SECTION E: EXAMINATION VENUE DETAILS Please tick the venue most suited to you: SOUTH AFRICA
Bloemfontein
Cape Town
Durban
Johannesburg Central* Midrand*
Pietermaritzburg
Polokwane
Port Elizabeth
Pretoria
Nelspruit
Stellenbosch
*The IMM GSM reserves the right to only use one of the venues in the Greater Johannesburg Metropole, or to allocate certain students to a specific venue due to venue capacity.
BOTSWANA
NAMIBIA
UNITED KINGDOM
ZIMBABWE
Gaborone Windhoek London Bulawayo Private Invigilation (Complete the Private Invigilation Application form)
Harare
OTHER Namely:
PLEASE NOTE: EXAMINATION VENUES CANNOT BE CHANGED AFTER 1ST APRIL IN SEMESTER ONE OR AFTER 1ST SEPTEMBER IN SEMESTER TWO.
SECTION F: STUDENT DECLARATION • I
have read the IMM GSM Prospectus and Student Yearbook. understand and accept all policies and procedures pertaining to the IMM GSM, including the IMM GSM’s examination policy, and agree to abide by the rules stated therein. • I understand and accept that upon my acceptance to the IMM GSM, I immediately become liable to the IMM GSM for the full programme fees and therefore undertake to pay the full programme fees on or before the due dates. • I understand and accept that should I withdraw from the programme at any time, I will give written notice of my intention and immediately pay all monies owing. • I
IMPORTANT: I understand and accept that for each semester a separate Postgraduate Registration Form must be completed and that no faxed or emailed Postgraduate Registration Forms will be accepted by the IMM GSM. STUDENT SIGNATURE
DATE
/
/ 20
National Office: Johannesburg Atlas Studio, 33 Frost Avenue, Braamfontein Werf, P O Box 91820, Auckland Park, 2006, Tel +27 (0)11 628 2000, Fax +27 (0)11 726 4505, Email [email protected] Durban Suite 9, The Lodge, Strathmore Park, 305 Musgrave Road, Berea, P O Box 35263, Northway, 4065, Tel +27 (0)31 202 5791, Fax +27 (0)31 202 5797, Email [email protected] Cape Town The Athenaeum Campus, Boundary Terrace, 1 Mariendahl Lane, Newlands, 7700, P O Box 23998, Claremont, 7735, Tel +27 (0)21 671 4426, Fax +27 (0)21 671 4424, Email [email protected] Zimbabwe Suite N & P, Sam Levy’s Village, Borrowdale, Harare, P O Box MP 394, Mount Pleasant, Harare, Tel +263 (4) 853 177, Fax +263 (4) 853 172, Email [email protected] The IMM Graduate School of Marketing (IMM GSM) is registered with the Department of Higher Education and Training (DHET) as a private higher education institution under the Higher Education Act, 1997. Registration certificate number 2000/HE07/013.
IMM GSM POSTGRADUATE REGISTRATION FORM P2
