Given and Family Names of Applicant (Student)

Age as on January 1, 2018

Gender

Academic Level as in January 2018

Kindly let us have the size of scrubs that you wear (if unsure - rather choose slightly bigger).

The student's/applicant's email address

Email address of a parent/family member taking responsibility to assist with arrangements for the program.

Student's mobile phone number:

Parent's/guardian's phone number - or a responsible adult family member/friend...

Your official physical address please

Academic institution (college/university) name

Kindly let us have information regarding allergies, medical conditions/problems and chronic medication - or anything else that you want to bring under our attention in this regard. Write "None" if no problems.

Phone number for person to contact in case of emergencies:

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 3000 characters).

The letter/s of recommendation should be a one-pager from e.g. a professor who knows you well, and should focus on character (ability to work in a diverse group, follow instructions and work ethics etc.). Academic performance is not a requirement.