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Personal Information

Name *
Surname *
Male or Female *
Date of Birth *
ID Number *
Country Of Birth *
Citizenship *
Cell Phone Number
Email Address *
Residential Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Postal Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Church Name and Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Senior Pastor's Name *
Senior Pastor's Phone Number *
Do you Require Accommodation in Pietermaritzburg? *
Yes I do require accommodationNo I do not require accommodation
Do you have a Drivers licence *
Yes I do have a drivers licenceNo I do not have a drivers licence
Date Drivers License was acquired? *

Parents / Guardian - Father

Name *
Surname *
Cellphone Number *
Email address *
Home Phone Number
Work Phone Number
Residential Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Postal Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Personal Private Information : (Optional)
for example : Parents are divorced, I have health issues, Living with my grand parents, etc.

Parents / Guardians Information Mother

Name *
Surname *
Cell Phone Number *
Email Address *
Home Phone Number *
Work Phone Number *
Residential Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Postal Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Personal Private Information : (Optional)
for example : Parents are divorced, I have health issues, Living with my grand parents, etc.

High School Attended

Highest Grade passed *
Year you completed school *

Tertiary Education

Institution Attended
Diploma / Degree obtained?
Year completed diploma / degree

Languages

Home Language?
Second Language (able to speak, read or write?)
Third Language (able to speak, read or write?)

Cultural

Can you play a musical instrument? *If yes, which instrument?
Have you ever played in a band? If not, would you be interested in playing in a band?
Have you had any dance or drama experience? Which?
List your hobbies or interests

Health

Rate your current health
Disabilities?
Specific dietary requirements
Name all medication you are currently taking:
List any allergies
Do you suffer from diabetes or asthma?
Name and Number of Medical Aid?

DOCUMENTS REQUIRED TO BRING WITH YOU:

DOCUMENTS REQUIRED TO BRING WITH YOU: *
2 X colour Passport size photos.Family doctors Health Clearance Certificate.Proof of valid Tetnus inoculation.Character reference letter from a Teacher, Pastor, Mentor or Youth LeaderPolice clearance letter stating that you have no criminal record and are allowed to work with childrenCurrent Passport and Visa for travelling to neighbouring countries. (Namibia, Bots, Zim, Moz)Drivers License if applicable

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Home
About DLA
Application
- Apply for Destiny Leadership Academy
- Overseas Students
Financial Outline
Blog
Contact Us