Application Form

1Course Details

2Applicant Details

3Current Employment Information

4Invoicing Details

Which course are you applying for?*
Select City*
- Cape Town
- Johannesburg
Year*

Name*
First Last
Preferred Name
Email address (for all correspondence)*
Physical Location (for group meetings)
Suburb*
Region*
Country*
Postal Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Telephone Number and Code
Include country and code if outside of SA)
Mobile phone number*
Include country and code if outside of SA)
Relationship status
No. & Ages of children (if applicable)
ID Number/Passport Number*
Date of Birth*
Educational background:*
Qualification Institute
Which Centre for Coaching or New Ventures West courses have you previously completed?
Course Name Year Facilitator
Where did you hear about the Centre for Coaching?
Do you have any disabilities of which we need to be aware?

Please advise how this account will be settled*
- Individual
- Company sponsored
Company Name
Finance Contact Name
Finance Contact Email
Invoicing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
VAT Registration Number
Purchase Order Number (if required)
Do you require an invoice before the deposit can be paid*
- Yes
- No
Please note that there is a deposit amount for each course to reserve your space, this amount is non-refundable and non-transferable.
1 page Motivation Letter
Accepted file types: doc, pdf, Max. file size: 32 MB.
Please provide a short letter (maximum of 1 page) telling us why you would like to do our ACC Course.
Photo*
Accepted file types: jpg, png, Max. file size: 32 MB.
Please provide us with a head and shoulders photograph. This photo is for admin purposes and won't be used publically without your permission.
Cancellation Policy:

More than 30 days before the course start date qualifies for a refund of the fees less the deposit amount.
- 30 to 14 days before the course start date is subject to 50% of the full fees.
- 14 days prior to the course start date results in a forfeit of 100% of the full fees.
- If balance payment has not yet been made, the programme fee becomes immediately due and payable.
Cancellations must be made in writing via Email.

Acknowledgement of Understanding:
I understand and agree that if I withdraw from the programme at any time after 14 days prior to the course start date, the Centre for Coaching is entitled to keep and retain the full tuition as consideration for assuming the responsibilities in undertaking the programme. If the tuition is being paid in installments, the full amount becomes immediately due and payable if, at any time and for any reason, I withdraw from the class.
*
- I hereby acknowledge that I have read the cancellation policy and accept these as terms of my application.

Qualification	Institute

Course Name	Year	Facilitator