Application form - Eagles Rising

Year Applying For *

2024
2025
2026

Date *

Full Names *

Surname *

ID Number *

Date of Birth *

Gender *

Email Address *

Confirm Email

Cell/WhatsApp Number *

Residential Address *

House Address

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

Check if same as above

Postal Address

House number

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

Parents/Guardian Details

Please select the appropriate block *

I stay with both my biological parents
I stay with one of my biological parents
I stay with guardians

Full Names (Parent 1) *

Surname *

ID Number *

Date of Birth *

Gender *

Email Address *

Confirm Email

Parent cell number *

Residential Address *

House number

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

Check if same as above

Postal Address

House number

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

Full Names (Parent 2)

Surname

ID Number

Date of Birth

Gender

Email Address

Confirm Email

Parent cell number

Residential Address

House number

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

Check if same as above

Postal Address

House number

Street name

City/Town

State / Province / Region

Zip / Postal Code

Country

At which school or institution did you study? *

Name of principal or responsible educator

E-mail of school *

School Telephone Num

When do you aim to complete or have you completed Grade 12 *

Select your Pass from the dropdown. Preference is given to Bachelor and Diploma Pass's. We are unable to process results for Certificate Pass *

Please complete the following table in full: (If you are currently in Grade 12, please use either your Grade 11 or your Grade 12 trail-exam results.)

I include my Grade 12
Grade 12 trial
Grade 11 result

Subjects

Result in %

Subjects

Result in %

My preferred language of communication is

Leadership Positions held?

Please provide us with a list of your hobbies

Please list any chronic diseases or allergies

What sport or cultural activity do you participate in?

Do you want to go to College or university? *

Which college or university do you intend to apply to?

If yes, would you need financial assistance? *

If yes, where would you apply for financial assistance

Career choice 1 *

Career choice 2

Reason for career choices

Reason for wanting to attend Eagles Rising Leadership Academy

I am a born again Christian *

I commit to contributing R1500 per month for 10 months

Upload your documents

Drop your file here or click here to upload You can upload up to 5 files.

Please make sure the following documentation is attached: 1. Picture of yourself 2. Your ID 3. Parents/Guardians ID 4. Copy of latest school report/ Grade 12 results. 5. Proof of payment. (R200,00 registration fee)

Declaration *

Signature