The Future Doctors Program Alberton, Gauteng, South Africa - Registration

Name*
First Last
Given and Family Names of Applicant (Student)
Age:*
Age as on January 1, 2023
Gender*
- Male
- Female
Choose a program:*
- 30 Aug. - 02 September in Alberton
- 2-5 October '23 in Centurion
- 4-8 December '23 in Johannesburg
- 11-14 December '23 in Cape Town
- Interested in 2024 programs
Please choose a program in 2022 - more programs will be added
Academic level: Jan 2023*
- Grade 9
- Grade 10
- Grade 11
- Grade 12
- Post Grade 12
Please enter your High School Grade - as from January 2022
Scrubs size*
- XS
- S
- M
- L
- XL
- XXL
Kindly let us have the size of scrubs that you wear (if unsure - rather choose slightly bigger).
Dietary Preference*
- No preference
- Vegetarian
- Halal
We will try our best to accommodate your preference
Email address student:*

The student's email address
Email address parent:*

Email address of the parent taking responsibility to assist with arrangements for the program.
Student's cell phone number:*
Only for emergencies - not for marketing purposes
Parent's phone number:*
Any reliable contact number of the parent/guardian taking responsibility to assist with arrangements for the program.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School name:*
If home schooled - enter "Home schooling"
School's Email address*

Email address of school
Schools phone number:
Contact person at school*
Preferably life sciences teacher
Medical information (if applicable):
Kindly report any medical conditions, allergies - including food allergies and/or chronic medication/s here:
Application letter*
Write an application letter to Dr Anton Scheepers with information about yourself (academics, achievements, etc.), your goals and dreams and why you believe you should be accepted into the Apprentice Doctor Program. (Maximum 3500 characters). If at school - give your current grade marks/symbols.
Name
This field is for validation purposes and should be left unchanged.

The Future Doctors Program Alberton, Gauteng, South Africa – Registration

The South African Future Doctors Programs: Registration - 2023