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FOR OFFICE USECAMPUS ID:EMPL ID:2022 APPLICATIONFOR UNDERGRADUATEADMISSIONSURNAME:FIRST NAME: Apply online at http://applyonline.uct.ac.za. Use this booklet only if you do not have access to the internet.If you are currently registered at UCT, and wish to transfer to another undergraduate programme, you must consult the Facultythat you wish to transfer to.Undergraduate applications close on 31 August 2021. We do not accept late applications.Complete this form using the information and codes found in the tables in the 2022 Directions for Undergraduate Applicants.Please complete this form in CAPITAL LETTERS in ink.Return this completed form by email to admissions-ug@uct.ac.za with the subject line “2022 Undergraduate ApplicationForm” or by post. As there may be delays with the post, we strongly encourage email submissions.DO NOT submit your application fee with this form. Refer to the 2022 Directions for Undergraduate Applicants for instructionsregarding application fee payments.UCT is aware that the current crisis related to COVID-19 will impact the regular operational timelines. Given thefluid situation that prevails all dates contained in our publications and correspondence are subject to change.

SECTION APERSONAL DETAILSIf you have applied to UCT before, enter your applicant/student number:Title (Table H):Date of birth:DDMMYYYYSurname:First name/s:Preferred firstname:Former surname:Surname onNational SeniorCertificate (forNSC writers only):Sex: (please tick one)Female:Are you a South African citizen?Male:YesNoHome language (Table H):Trans:YesAre you a South African permanent resident?NoInclude a certified copy of your South Africanidentity card or documentSA identity number:If you are a citizen or permanent resident in a country other than South Africa, please provide details here:Country (Table I):Citizenship status (please tick)Passport number (where available)CitizenPermanent ResidentCitizenPermanent ResidentCitizenPermanent ResidentInclude a certified copy of your passportIf you need assistance because of a disability, please specify the disability/ies (Table H) so we can plan to help you:SECTION BNATIONAL BENCHMARK TEST (NBT) NUMBERAll applicants to undergraduate programmes (with the exception of the Faculty of Engineering & the Built Environment which does not have a NBTrequirement) normally resident, or at school, in South Africa, and all Health Sciences applicants, wherever resident, must write the NBTs. NBTs mustbe written by 2 October 2021, except for Health Sciences which must be written by an earlier date. Please wait for correspondence about the HealthSciences NBT date. If you are required to write the NBTs, you must register for NBTs before submitting this form. Enter your 14-digit NBT registrationnumber and, if you wrote before 2021, the year the NBTs were written. NBT results are only valid for two years prior to the year of application; so if youwrote the NBTs in 2019 or 2020, the results remain valid but you may choose to rewrite in 2021.NBT registration number:Year written: 2SECTION CChoice1st Choice2nd Choice0Y2021 test date: DYDMPROGRAMMES OF STUDY FOR WHICH YOU ARE APPLYINGAcademic plan code (Table A)Only forFaculty ofScienceapplicantsPage 1 of 5ChoiceAcademic plan code 2 (Table A)1st ChoiceSB0012nd ChoiceSB001M

SECTION DYOUR CONTACT DETAILSHome (street) address:Home (postal) address: (if different from Home (street) address)Postal/zip code:Postal/zip code:Country tel code: Dialling code:Telephone number:Country tel code: Cellular number:Email address:SECTION EPARENT / GUARDIAN CONTACT DETAILSCompulsory if you are under 18 years.Title (Table H):Surname of parent/guardian:First names of parent/guardian:Home (street) address:Country tel code:Cellular number:Country tel code:Dialling code:Telephone number:Postal/zip code:Email address:Identity/passport number of parent/guardian:Relationship to you:Relationship code (Table J):SECTION FFEE PAYER INFORMATIONIf your Fee Payer is also your parent/guardian, and you completedSection E, you do not need to complete this section. If not, this section is compulsory.Title (Table H):Surname of parent/guardian:First names of parent/guardian:Home (street) address:Country tel code:Cellular number:Country tel code:Dialling code:Telephone number:Postal / zip code:Email address:Identity/passport number of parent/guardian:Relationship to you:Relationship code (Table J):Page 2 of 5

SECTION GREDRESS & DIVERSITY INFORMATION: SA APPLICANTS ONLYThis section applies to South African citizens and permanent residents only and is compulsory.The University’s redress and diversity policies apply to South African undergraduate applicants whose parent/s was/were classified underapartheid as Black, Coloured, Chinese or Indian. Your responses to the following questions are used to calculate your redress categoryand disadvantage factor. The disadvantage factor will be used in the calculation of your Weighted Points Score. Refer to page 10 of the2022 Undergraduate Prospectus for an explanation of the University’s Admissions Policy.1.Under apartheid, my mother was classified as (please tick only one):BlackColouredI choose not to answer this question2.ChineseIndianWhiteDo not knowWhiteDo not knowMy mother did not live under apartheidUnder apartheid, my father was classified as (please tick only one):BlackColouredI choose not to answer this questionChineseIndianMy father did not live under apartheid(Table H)3. What is/was your mother’s first language?4. What is or was the highest level of education of each of parents/guardians, andyour grandparents (highest of all of them)? Please tick one box: (where nGrandparentsUniversity or Technikon degree .University or Technikon certificate or diploma.Technical College certificate, trade certificate or similar certificate.Matric/Grade 12/Senior certificate.Some formal schooling.No formal schooling.I do not know . . .5. Does or did your family receive a child-support grant on your behalf?. . .YesNoI do not know6. Does or did your family rely on a social pension from the State?.YesNoI do not knowSECTION H2021 SECONDARY SCHOOL-LEAVING EXAMINATION DETAILSComplete this section if you are writing a school-leaving examination in 2021. Supply only details of secondary schools located in SouthAfrica. If you attend school outside of South Africa, omit secondary school details.Schoolname:School subjects to be writtenthis year:(Table B)Code(Table D)(Table C)Schoolcode:Examining authority:School address:Postal code:For Cambridge Assessment International Education applicants: Centre no.:Candidate no.:Did you attend any other secondary school before enrolling at your present school?YesNo(Table B)If yes, please provide the codeof your previous school:If yes, in which year did you firstenrol at your present school:Page 3 of 5YYYYLevel(Table E)

SECTION ISECONDARY SCHOOL-LEAVING AND POST-SCHOOL INFORMATIONComplete this section if you have already left school. Supply only details of secondary schools located in South Africa. If you attendedschool outside of South Africa, omit secondary school details. Please enclose certified copies of your final results and certificate/s.(Table B)LastSchoolschoolcode:attended:School address:Date written:DDMMYYYY(Table C)ExaminingAuthority:Postal code:DETAILS OF ACTIVITIES SINCE LEAVING SCHOOL OTHER THAN TERTIARY EDUCATIONIf you have left school and are not at a tertiary institution, you must complete this section.YearActivityCode (Table F)YearActivityYYYYYYYYYYYYYYYYCode (Table F)TERTIARY EDUCATION DETAILSIf you have attempted any tertiary education or are currently registered at a tertiary institution, you must complete this section.Please enclose certified copies of your transcripts/certificates/result statements.Degree / diploma forYear ofSchool name:School code: (Table B)which registeredregistrationSECTION JQualificationcompletedHOUSING APPLICATIONPlease tick the appropriate box to apply for UCT accommodation.I wish to apply for student housing:YesNoPlease note we cannot guarantee accommodation for all students.SECTION KFINANCIAL ASSISTANCEPlease tick the appropriate box to indicate your intention to apply for student financial assistance.I intend to apply for UCT/NSFAS financial assistance:YesNoNOTE: All UCT financial assistance and NSFAS applications for funding are managed by NSFAS. Apply directly to NSFAS at www.nsfas.org.zaand submit all the supporting documents to enable the easy processing of your application. The closing date for financial assistance will beavailable on the NSFAS website.Page 4 of 5