018 Student Application Form - Student Accommodation Potchefstroom

Enter ID / Passport Number *

Enter Date of Birth *

Gender *

Enter Phone Number *

Enter Residential Address *

Enter Emergency Contact Name *

Enter Emergency Contact Phone *

Emergency Contact Relationship *

Enter Institution / University *

Enter Course / Programme *

Academic Level *

Enter Student Number *

Year of Study *

Enter Preferred Unit

Room Type *

Do you have a roommate? *

Enter Roommate Name

Enter Special Requests

ID / Passport *

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Academic Document *

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Proof of Residence *

Browse

Guardian Document *

Browse

Please Note: The application fee does not guarantee acceptance.