A P P L I C A T I O N   F O R M
                                                               Brave Heart Scholarship 2022
                The non-refundable Administration Fee of R500.00 must be paid to: Clifton Prep School Nottingham Road  
                           First National Bank:  Mooi River 220525   Account No: 53050771197    Reference: Applicant Surname/Year of entry  
                           International Swift Code: FIRNZAJJ 305 
                The application must be accompanied by the following: 
                            A copy of the applicant’s birth certificate                A copy the applicant’s latest school report
                            Proof of payment of the application fee                    Copies of all specialist reports, if applicable
                           A letter of motivation detailing your child's
                              achievements
                Proof of payment and documents must be e-mailed to the Admissions Secretary admissions@cliftonprep.org.za. 
                DETAILS OF PROSPECTIVE PUPIL: 
                Surname: _____________________________________                      First Names: ______________________________________ 
                Citizenship:  ___________________________________                   Preferred Name: __________________________________ 
                Country of Birth: _______________________________                   Date of Birth: _____________________________________ 
                Gender: ______________________________________                      Home Language/s: _________________________________ 
                Proposed entry Grade: __________________________                    Year of Entry: _____________________________________ 
                Day Scholar                                        Weekly Boarder:                                              Termly Boarder 
                Is there anything else we need to know about your child that will impact on his/her daily living?  __________________ 
                 _________________________________________________________________________________________________ 
                 _________________________________________________________________________________________________ 
                Current School: ____________________________________________________________________________________ 
                Current School e-mail address: ________________________________________________________________________ 
                Siblings (Name & Date of Birth):  ________________________________________________________________________ 
                Any Previous Relatives/Siblings at Clifton? (Name, relationship, years attended & sporting house)  _____________________ 
                 _________________________________________________________________________________________________ 
                PARENT/GUARDIAN DETAILS: 
                Guardian 1                                                          Guardian 2 
                Relationship to Applicant: ________________________                 Relationship to Applicant: ___________________________ 
                Title: _________________________________________                    Title: ____________________________________________ 
                Surname: _____________________________________                      Surname: ________________________________________ 
                First Name:  ___________________________________                    First Name:_______________________________________ 
                ID/Passport No.:  _______________________________                   ID/Passport No.:  __________________________________ 
                Citizenship:  ___________________________________                   Citizenship:_______________________________________ 
                Home Language: _______________________________                      Home Language: __________________________________ 
                Mobile Number: _______________________________                      Mobile Number: __________________________________ 
                Home Number: ________________________________                       Home Number: ___________________________________ 
                E-mail: _______________________________________                     E-mail: __________________________________________
                              Nottingham Road, KwaZulu-Natal, South Africa,  Private Bag X01, Nottingham Road, 3280 South Africa 
                             E-mail: reception@cliftonprep.org.za      Telephone: +27 (0)33 266 8200/212      www.cliftonnotties.org.za
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             Postal Address: ________________________________    Postal Address: ___________________________________ 
              _____________________________________________       ________________________________________________ 
             Postal Code: ___________________________________    Postal Code: ______________________________________ 
             Physical Address: _______________________________   Physical Address: __________________________________ 
              _____________________________________________       ________________________________________________ 
             Occupation: ___________________________________     Occupation: ______________________________________ 
             Employer:  ____________________________________     Employer: ________________________________________ 
             Marital Status: _________________________________   Marital Status: ____________________________________ 
             If divorced / separated please state with whom the child lives. If the address differs from above then please state the 
             address: 
              _________________________________________________________________________________________________ 
              _________________________________________________________________________________________________ 
              _________________________________________________________________________________________________ 
             How did you hear about Clifton? ______________________________________________________________________ 
             Please note:  
                 •   it is imperative that you keep the school advised of any change of contact details
                 •   that Clifton will contact the child’s current school for financial clearance
                 •   that Clifton will run a credit check
                 •   the Clifton Headmaster may contact the child’s current school for a confidential report
                 •   submission of this application form does not guarantee an invitation to assessments
                     and interviews.
             Signature of Parent/Guardian: ___________________________________   Date: _______________________________ 
                        Nottingham Road, KwaZulu-Natal, South Africa,  Private Bag X01, Nottingham Road, 3280 South Africa 
                       E-mail: reception@cliftonprep.org.za      Telephone: +27 (0)33 266 8200/212      www.cliftonnotties.org.za
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