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AHPCSA Registration Form

The document is an application form for registration as a student with the Allied Health Professions Council of South Africa. It requires personal details, educational background, and proof of payment for registration fees. Applicants must specify their chosen allied health profession and attach relevant documentation to complete the application process.

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connorrixon06
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30 views2 pages

AHPCSA Registration Form

The document is an application form for registration as a student with the Allied Health Professions Council of South Africa. It requires personal details, educational background, and proof of payment for registration fees. Applicants must specify their chosen allied health profession and attach relevant documentation to complete the application process.

Uploaded by

connorrixon06
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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The Allied Health Professions Council of South Africa

Private Bag X28, Lynnwood Ridge,0040


Castelli Suite, Il Villaggio 5 de Havilland Crescent South, Persequor
Technopark, Pretoria Telephone (012) 349 2331 Fax: 086 507 4092 e-mail:
info@ahpcsa.co.za

For office use only


Date received:
Receipt number:
Amount :

Return this application together with proof of payment to:


Surnames A-L: camille@ahpcsa.co.za
Surnames M-Z: mpho@ahpcsa.co.za

APPLICATION FOR REGISTRATION AS A STUDENT

1. Please mark the relevant allied health profession clearly.


ACUPUNCTURE PHYTOTHERAPY
CHINESE MEDICINE AND ACUPUNCTURE THERAPEUTIC AROMATHERAPY
CHIROPRACTIC THERAPEUTIC MASSAGE THERAPY
HOMOEOPATHY THERAPEUTIC REFLEXOLOGY
NATUROPATHY
UNANI TIBB

Personal details
2. Surname: 3. Nationality:
4. Race: (required for statistical purposes)
5. Full first names
6. Identity number: (attach certified copy of photograph
page of ID)
7. Postal address:
Code:
8. Residential address:
9. Tel: (Home): ( ) (Cell): ( )
(Fax): ( ) (E-mail):

Education and training


10.Course enrolled for:
(Proof of registration on the official letterhead of the educational institution concerned to be
attached)

1
11. Year of course: (1ST, 2ND ETC) 12. Student number:

13. Educational institution:


14.Highest secondary school standard attained: (attach certified
copy)
15. In respect of which profession(s) (if any) are you already registered with the council -
state council registration number(s) and list profession(s):

16. In respect of which profession(s) (if any) are you already registered with any other
statutory health council - state council(s), council registration number(s) and
profession(s):

17. Please indicate the minimum duration of the course indicated under point 10 and
whether it is a full- time class attendance, part-time class attendance, distance or
correspondence course:

18. You are required to attach the council registration fee of R680 for initial registration for a
course (the first year of registration with the Council), and R680 per year thereafter for
second and subsequent years of study.

I hereby certify that all the information provided and documentation submitted is true and
correct.

_
Signature of student Place and date

Banking details
First National Bank, Hatfield branch, Code 252 145, Account number 5106 255 1862. Our
account holder is the Allied Health Professions Council of South Africa or AHPCSA. SWIFT Code
(for international payments) FIRNZAJJ

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