Applications for 2009 have closed. Offers of place have been made. |
| NUMERICAL INFORMATION: Please insert dashes (-) not spaces between digits e.g. Country Code (254) + Area Code(2) + (679694) Telephone Number should read 254-2-679694 |
| * Required fields |
| Applicant Details |
| Surname: | * | | Given (First) Names: | * |
| Proposed Date of Entry: | | | Into Grade: |  |
| Date of Birth: | | | Present School: | |
| Country of Birth: | | | Home Language: | |
| ID/Passport No. | | | Religious Denomination: | |
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| Please indicate how you heard about Michaelhouse: |
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| If you chose Family Connection above, please complete the following: |
| Relationship: | First Name & Surname: | | Year Left Michaelhouse: |
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| Relationship: | First Name & Surname: | | Year Left Michaelhouse: |
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| Parent/Guardian Details |
| Father | | | Mother | |
| Surname: | | | Surname: | | |
| Title: | | | Title: | | | |
| First Name: | | | First Name: | | | |
| ID/Passport No. | | | ID/Passport No. | | |
| Marital Status: | | | Marital Status: | |
| Home Address: | | | Home Address: | |
| Postal Address: | | | Postal Address: | |
| Post Code: | | | Post Code: | |
| Home Tel. No. | | | Home Tel. No. | |
| Work Tel. No. | | | Work Tel. No. | |
| Fax No. | | | Fax No. | |
| Cellphone No. | | | Cellphone No. | |
| Email Address: | | | Email Address: | |
Company Name: | | | Company Name: | |
| Occupation: | | | Occupation: | |
| Position: | | | Position: | |
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