First Name*
Surname*
Identity Number*
Passport Number (if applicable)
Gender*
Date of Birth*

Year
Month
Date
Province*
Mobile number*
Work Number*
Home Number*
E-mail*
Employer - Company Name*
Job Title*
Employer Contact Person*
Employer Email Address*
Employer Contact Number*
Select a Qualification (NQF 5 or NQF 7)*
REGENT Business School application form
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Bursary Agreement duly signed
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Nomination Form with valid Skills Development Levy number
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Retail Management Development Programme Application