Learner Support Centre Application Form

2012

Instructions on completing the application form

1. 2. 3. 4. All prospective Learner Support Centres seeking affiliation with Vision International College must complete this application form. Please submit all the relevant documentation requested (see the last paragraph of each section) with the application form. Applications must be complete to enable Vision International College to proceed with the application process, and if you need additional information or clarity on any aspect of the application form, contact the Regional Head Office. Please use a black pen and print clearly when completing the form.

1. Details of Responsible Person for the Learner Support Centres This Person is responsible to Vision International College for all communication between the Learner Support Centres and Vision International College. Title (Past,Dr,Rev etc.) Surname Residential Address Name .. Cell No

Postal Address (if

different from residential address)

Telephone No Email address

Attached appointment letter from, Church Council or Organisation. Attached Curriculum Vitae of Responsible Person.

2. Details of Covering Ministry or Organisation Name of Ministry or Organisation Name of Pastor or Leader Physical Address of Ministry or Organisation Telephone No Details of Registration (e.g.) N.PO/NGO etc. Registration No Church Denomination
(part of a group or independent)

Email address: When established

Attached Church or Organisation registration certificate and proof of physical address.

3. Tutoring / Facilitating Staff List the names of tutoring / facilitating staff Fields / Subjects of interested (e.g. Biblical
Studies, New Testament etc.)

Please Attach Curriculum Vitae`s of Staff

4. Proposed Name of Learner Support Centre

5. Program that Learner Support Centres wants to tutor Under Graduate (Certificate IV Advanced Diploma) Post Graduate (Graduate Certificate Graduate Diploma )

NB: 1. To tutor the under graduate program, tutoring staff at Learner Support Centres must hold at least a Bachelors Degree or a Post Graduate Diploma 2. To tutor the Post Graduate Program, tutoring staff must hold at least a Masters Degree. Tutoring Staff that dont hold the above mentioned qualifications can apply for Recognition of Prior Learning (RPL) with Vision to obtained the required qualifications if the evidence provided is sufficient and meet the outcomes of the required qualifications. An RPL fee for this service is required. 6. Application / Affiliation Fee The yearly affiliation fee is R 1000.00, payable upfront. A further R1000 is payable upon starting, for compulsory Induction Training workshops. This fee of R1000 only covers the Western Cape Metropole Area for training done at the national office (For all induction training outside the Western Cape Metropole, the Learner Support Centres will be held responsible for accommodation, Meals and travelling of National office staff of which the R1000 is also included. Please attach proof of payment

NB: Vision International College will process your application as soon as we received youre full completed application, with all the required documentation. You will be notified in writing and we will forward an affiliation certificate from us upon signing our covenant agreement/ memorandum of understanding (MOU).

. Name and signature of responsible person . Co-ordinator (Vision International College)

. Date . Date