APPLICATION FOR NURSING COURSES
PROPOSED QUALIFICATION:
Diploma in Nursing: Code R171
APPLICATION FEE R500.00-00 (non-refundable)
Payment Yes No Student No.:
Personal Details
Surname:
First Names:
Identity No: Home Language:
Race:
Gender: M F
Contact Tel: Home Cell Work
Marital Status: Married Single
Street Address:
Postal Address:
Details of person responsible for fee payment:
Name:
Relationship:
Address:
Contact Tel:
Email address:
Signature of person responsible for fees:
1
Details of next of kin:
Name:
Relationship:
Address:
Contact Tel: Cell: Work:
Email address:
Matric or Equivalent Information
Institution Year 2024
Subjects Symbols before 2008 Grade Levels after
2008
Total Points 28 For official
use only
References Two (2)
Name Relationship Cell Numbers
1.
2.
Documents Required (Submit with Application Form)
NB Certification must not be older than 3 months
A certified copy of your Matric Certificate or equivalent in case of International students
A certified copy of your South African Identity document
A certified copy of your current South African Nursing Council Registration Certificate
(If applicable)
A copy of your 2021 South African Nursing Council receipt. Please note proof of
payment of subscription fees will not be accepted as proof of registration with SANC.
A testimonial from your Matron/Supervisor if you are employed and this should not be
older than three months.
2
If accepted, you will have to do and submit proof of the following:
Hepatitis B Vaccine (as indicated)
Complete Application forms for placement
Indemnity forms (Hospital placement area and college
Enter into a contract with the College
Proof of Indemnity with an organization of choice e.g. Denosa, Hospersa
Nehawu etc.
FEE STRUCTURE FOR DIPLOMA IN NURSING (R171)
DESCRIPTI BREAKDOWN OF FEES R.C PAYABLE BY TOTAL COST
ON
Non – For first year only to book a R5 000 Upon acceptance
refundable space in the Diploma in of application
Registration Nursing programme
fee
First year Tuition fee See details below
fees South African Nursing
Council (SANC) registration
fee OR ………….
Indemnity for the current With submission
year (this include Of valid proof of
administrative cost). indemnity
This portion of the fees will
be excluded ONLY if valid
and current proof of
indemnity that covers the
student for the first (1st)
twelve (12) months of the
course
Second Year Tuition fee Before
fees commencement
of the Second
year
3
Third Year Tuition Fee Before
commencement
of the Third year
PAYMENT TERMS, FIRST YEAR
Payment is to be made in full, once off, or on the following terms:
DATE/OCCASION Amount
Upon confirmation of acceptance of application
Before commencement of lectures
6 Equal monthly due before the last day of each month
from March to August
Note: Proof of payment must be submitted to the Administration Officer or emailed
to both pvilakazi@[Link] and
sndaba@[Link].
Payments must be made by Bank Deposit only!
Account Name: St Mary’s Hospital Nursing College
First National Bank Account: 62826108153
Branch code: 250655
Reference: Diploma in Nursing /R171 Name & Surname
Accommodation: Enquiries to be directed to the College Secretary Ms. Ntombela:
Contact Number: 083 749 8566
Closing date for submission of the application form: …………………….
Signature of Applicant: …………………………………. Date: ………………………
For official use only
Received by: …………................................................ Date: …………………………....