Online Application - STEM

StemLab oNLINE APPLICATION pORTAL

Please fill out the application to be considered for our programs.

Welcome to the StemLab Franchise Prospectus for South Africa

LEARNER PERSONAL INFORMATION

Title *

Full Names *

Date Of Birth *

Gender *MaleFemale

Phone Number (Learner)

Email Address *

Current School *

Grade *

Learner Status *

Any medical conditions? *YESNO

If Yes describe

Any physical or learning disabilities? *YESNO

If Yes Please Describe

PARENT /GUARDIAN PERSONAL INFORMATION

Title *

Full Names *

Occupation *

Employer *

ID Number *

Work Phone Number *

Mobile Number *

Email Address *

Street Address

Postal Address

EMERGENCY CONTACT DETAILS

Title *

Full Names *

Mobile Number *

Work Phone Number

Email Address *

Relationship *

INDIVIDUAL RESPONSIBLE FOR FEES

Title *

Full Names *

Occupation *

Employer *

ID Number *

Work Phone Number *

Mobile Number *

Email Address *

Relationship *

PAYMENT METHOD

Campus *

Select your modality of learning *Full-TimeOnline

Method of Payment *Full Tuition FeesMonthly

Monthly Installments3 x Months6 x Months9 x MonthsIf Monthly Select How

Payment Method (Banking Details: FNB / ACC No: 63116114602 / BRANCH CODE: 204209) *EFTCARD

Notes

COURSE SELECTION

Select Course Of Interest *Robo - Kids (6 - 9) - 12 Month MembershipCoding - Kids (10 - 11) - 12 Month MembershipWhizz - Kids ( 13 - 15) - 12 Month MembershipMaster - Kids (16 - 18) - 12 Month Membership

HARDWARE SELECTION *Robotics & Coding Kit ( Compulsory)Laptop / iPAD ( Compulsory)Apparel & OHS Kit3D Printer3D MouseHeadsetRequired items for registration can be purchased here www.shop.stemlab.co.za.

SUPPORTING DOCUMENTATION

ID OF APPLICANT / PASSPORT OF PAYEE *

No file chosen

Proof of Payment *

No file chosen

STEMLab Registration Terms and Conditions

Consent *

Yes, I agree with the terms and conditions.

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