IPSA - Online Application Form

IPSA Application form

Please note: Have your latest transcripts scanned and ready for upload at the end of this form

Programme Details

Applicant's Personal Details

Gender

MaleFemale Invalid Input

Title (Mr./Mrs./Ms./Dr./Etc.)

Invalid Input

Initial(s)

Invalid Input

Surname

Invalid Input

First Names (In Full)

Invalid Input

Maiden Name (married Women)

Invalid Input

Date of Birth

Invalid Input

Identity Number

Invalid Input

Passport Number

Invalid Input

Marital Status

SingleDivorcedMarriedWidowed Invalid Input

Address Details

Postal Address

Invalid Input

Postal Code

Invalid Input

Street Address

Invalid Input

Postal Code

Invalid Input

Email Address

Invalid Input

Home Telephone

Invalid Input

Work Phone (if Applicable)

Invalid Input

Cellphone

Invalid Input

International Telephone (incl dialing code)

Invalid Input

International Cellphone (incl dialing code)

Invalid Input

Mother / Guardian / Next of Kin Details

Title (Mr./Mrs./Ms./Dr./Etc.)

Invalid Input

Relationship

Invalid Input

Name

Invalid Input

Surname

Invalid Input

Occupation

Invalid Input

Employer

Invalid Input

Contact No.

Invalid Input

Email Address

Invalid Input

Father / Guardian / Next of Kin Details

Title (Mr./Mrs./Ms./Dr./Etc.)

Invalid Input

Relationship

Invalid Input

Name

Invalid Input

Surname

Invalid Input

Occupation

Invalid Input

Employer

Invalid Input

Contact No.

Invalid Input

Email Address

Invalid Input

Other Particulars

Home Language

EnglishAfrikaansArabicOther Invalid Input

Religious Affliation

Invalid Input

Population Group (Compulsory information required for government reporting purposes)

AfricanColouredIndianWhiteOther Invalid Input

Non-South African citizens, please indicate your country of origin

Invalid Input

Academic History

Supply full detail of studies at higher education institution(s). The following are regarded as higher education institutions: universities, previous technicon, and teachers' training and technical colleges. In the event of discontinuation of studies, indicate the date of cancellation.

Institution 1

Year From

Invalid Input

Year To

Invalid Input

Higher Education Institution

Invalid Input

Field of Study (e.g. BA, BCom, MSc,)

Invalid Input

Student Number

Invalid Input

Result (e.g. cancelled, failed, degree obtained)

Invalid Input

Institution 2

Year From

Invalid Input

Year To

Invalid Input

Higher Education Institution

Invalid Input

Field of Study (e.g. BA, BCom, MSc,)

Invalid Input

Student Number

Invalid Input

Result (e.g. cancelled, failed, degree obtained)

Invalid Input

Institution 3

Year From

Invalid Input

Year To

Invalid Input

Higher Education Institution

Invalid Input

Field of Study (e.g. BA, BCom, MSc,)

Invalid Input

Student Number

Invalid Input

Result (e.g. cancelled, failed, degree obtained)

Invalid Input

South African Matric Details

Highest grade passed

Invalid Input

Year

Invalid Input

Examination Number (if available)

Invalid Input

Type of certificate

South African Matric type

Joint Matriculation Board Full Exemption
Grade 12 (National Senior Certificate (NSC) – with relevant endorsement)
National Certificate Vocational (NCV) (N3, N4, N5, N6)
Independent Examination Board (IEB)
Senior Certificate (Before 2008)
Other Matric (Specify):
Invalid Input

Other Matric (Specify):

Invalid Input

Matriculation Endorsement (Specify endorsement type e.g. certificate, diploma, degree)

Invalid Input

International Matric type

HIGCSE
IGCSE / O – Level
IB (International Baccalaureate)
A-Level
Other Matric (Specify)
Invalid Input

Other Matric (Specify):

Invalid Input

Matriculation Endorsement (Specify endorsement type e.g. certificate, diploma, degree)

Invalid Input

High School Details

Name of school attended

Invalid Input

School postal address

Invalid Input

City/ Town

Invalid Input

Postal Code

Invalid Input

Province

Invalid Input

Islamic Education History

Have you studied Islam before?

YesNo Invalid Input

If yes, indicate with √ tick.

Madrasah
High School
College
Varsity
Adult School
IPSA
Other
Invalid Input

Specify the subjects and level completed:

Year

Invalid Input

Year

Invalid Input

Year

Invalid Input

Year

Invalid Input

Year

Invalid Input

Subjects

Invalid Input

Subjects

Invalid Input

Subjects

Invalid Input

Subjects

Invalid Input

Subjects

Invalid Input

Level

Invalid Input

Level

Invalid Input

Level

Invalid Input

Level

Invalid Input

Level

Invalid Input

Results

Invalid Input

Results

Invalid Input

Results

Invalid Input

Results

Invalid Input

Results

Invalid Input

Can you read Qur’an?

YesNo Invalid Input

If yes, indicate how you rate your reading ability and speed?

Very GoodGoodAverageWeak Invalid Input

Did you study Arabic as a language?

YesNo Invalid Input

Can you write Arabic script?

YesNo Invalid Input

If yes, indicate how you rate your writing ability?

Very GoodGoodAverageWeak Invalid Input

Have you participated in a Ḥifẓ (Memorization) programme before?

YesNo Invalid Input

If yes, state the period of the programme

Invalid Input

List your Ḥifẓ lecturer’s name

Invalid Input

How many Ajzā you have completed

Invalid Input

Are you currently in the teaching profession?

YesNo Invalid Input

If yes, indicate where you are currently teaching?

Invalid Input

Credits / Deferments

Are you applying for subject credits?

YesNo Invalid Input

Are you applying for subject deferment?

YesNo Invalid Input

Medical Condition

The College must be informed of certain disabilities in order to determine whether it is able to make special arrangements to accommodate persons with such disabilities. It is the prospective student`s responsibility to inform IPSA and to make a declaration to the relevant professional board/s in this regard.

Do you have a medical condition?

YesNo Invalid Input

If yes, indicate the nature?

Sight
Hearing
Communication (Talking, listening)
Physical (Moving, standing, grasping)
Intellectual (Difficulties in learning)
Emotional behaviour & psychological)
Multiple
Physically challenged, but unspecified
Invalid Input

If yes, specify

Invalid Input

Are you currently using medication?

YesNo Invalid Input

List contact details of an emergency contact in the case of an emergency.

Name and Surname

Invalid Input

Telephone

Invalid Input

Relation to Applicant

Invalid Input

Cellphone

Invalid Input

Fees and Payment

Title (Mr./Mrs./Ms./Dr./Etc.)

Invalid Input

Initial(s)

Invalid Input

Surname

Invalid Input

Postal Address

Invalid Input

Postal Code

Invalid Input

Street Address

Invalid Input

Postal Code

Invalid Input

Relationship

Invalid Input

Identity Number

Invalid Input

Cellphone

Invalid Input

Email Address

Invalid Input

Alternate Contact Person

Title (Mr./Mrs./Ms./Dr./Etc.)

Invalid Input

Initial(s)

Invalid Input

Surname

Invalid Input

Occupation

Invalid Input

Relationship

Invalid Input

Contact No.

Invalid Input

Email Address

Invalid Input

Employer

Invalid Input

Please upload the following
1. Transcript of latest results achieved
2. Degree Certificate (if applicable)

Upload Documents(*)

Please upload your latest transcripts

Click for Security(*)

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Connect with us

Cnr of Johnston & Duine Road,
Rylands Estate 7764, Cape Town,
South Africa.
PO Box 38316, Gatesville, 7766

dummy+27 21 638 1121

dummy info@ipsa-edu.org

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