Kaleidoscope Technological Centre Online Application Form

Our contact details: Telephone Number: 023 348 7616/ 023 348 7630 E-mail: [email protected] Fax: 023 348 7633 Postal address: 20 Adderley Street, Worcester 6850

Contact person(s): Applications: Corné du Bois (023 348 7616) Enquiries: Philip Crouse (023 348 7630)

PLEASE NOTE: All fields must be completed and all additional information and documents must be submitted using the above contact details before your application can be processed. Your place in the course(s) will only be booked after full payment has been received.

The following documents must be submitted: 1. A certified copy of your ID 2. A certified copy of highest academic qualification

Accommodation We are unable to provide accommodation to visiting students, but please see contact details for possible accommodation below:

1. Tolbos Backpackers Contact: Hector Loftus 072 8877007 / 023 3477145 2. Da Rooms B&B Contact: 072 250 7471 3. The Habit Contact: 023 3423538 4. Zonneweelde Guest House Contact: 023 342 6953 5. Wykeham Lodge Contact: 023 347 3467 Section A: Personal details of applicant

Surname:

Full name(s):

ID number:

Date of birth (yyy/mm/dd):

Gender (male/female):

Home address:

Postal code:

Telephone number (home):

Cellphone number:

E-mail address:

Marital status (married/divorced/single):

Place of birth:

Please state your educational qualifications:

Please state your current and previous work experience:

Section B: Parent/guardian if student is a minor (under 18)

Relationship to student:

Full name(s) and surname:

Home address:

Postal code:

Home telephone number:

Cellphone number: Work telephone number:

Section C: Enrolment

Please indicate the module(s) you are enrolling for with "yes" in the field next to the course number and name below.

Module 1 - An introduction to VoiceOver, SIRI, Zoom and the i-device: Module 2 - Communication and IOS: Module 3 - Getting organised: Module 4 - Accessable apps for the blind:

Do you want to receive training in VoiceOver/Zoom/Both? Please specify:

Cost per module: R1500.00 before commencement of training.

Is the student responsible for own tuition (yes/no)?

If no, please state the full details of the company/person responsible for tuition:

Registered name of company:

Name and surname of responsible person:

Position:

ID number:

Postal address:

Postal code:

E-mail address:

Telephone number:

Section D: Skills and abilities iPhone/iPad use: Have you ever used VoiceOver (yes/no):

Have you ever used Zoom (yes/no):

If you have answered “yes” to any of the above two questions, please describe your use:

Do you own an iPhone/iPad (yes/no):

If you answered “yes”, please state which device you have:

Have you ever used an iPhone or iPad (yes/no):

If you answered “yes”, please explain your use of the i-device:

Why do you want to be trained in the use of Apple IOS/iPhone and iPad:

What do you want to achieve with your APPle IOs iPhone and iPad training:

Are you fluent in English (yes/no):

If you answered “no”, what is your use of English:

Are you competent in reading and writing English (yes/no):

If you answered “no”, please explain:

Can you hear well (yes/no):

If you answered “no”, please explain:

Can you touch type on a normal keyboard (yes/no):

Please describe your keyboard competency:

Section E: Payment details

Please note: payment is due in full before commencement of training. You may make payments directly into our bank account. Should you not be able to pay the amount in full in advance, contact us to make alternative payment arrangements. Bank Absa, Worcester Takkode 632 005 Branch Code Rekening Naam Instituut vir Blindes / Institute for the Blind Account Name Rekening Nommer 0440 159 087 Account Number Stuur bewys na Fax:+27 (0) 23 347 3665 Send proof of payment to Vir Aandag / ATT: Belinda Coetzee [email protected] Verwysing TECH & student se naam Reference TECH & student’s name