Learner Application Form 2027 - Khomas Directorate of Education

KHOMAS REGIONAL COUNCIL

Directorate of Education, Innovation, Youth, Sports, Arts & Culture

2027 LEARNER APPLICATION FORM

Pre-Primary · Grade 1 · Grade 8 | Circular Form ED:03/2026 Applications are FREE · Khomas residents receive first priority

FOR OFFICIAL USE UID: Date received: ______________ School code: __________

Grade applying for: Pre-Primary Grade 1 Grade 8 No Namibian birth certificate (UID 7777777)

A. Learner details

Surname

First name(s)

Date of birth

Place of birth

Gender (M/F)

Birth certificate number

Nationality

Home language

Religion / denomination

Special needs / learning support (if any)

B. Previous schooling

ECD centre / previous school

Last grade completed

Reason for transfer (if applicable)

C. Parent / guardian details

Guardian 1 - full name

Relationship

ID number

Occupation

Employer

Cell phone

Marital status

Guardian 2 - full name

Relationship

Cell phone

D. Address & residency

Residential address

Constituency

Postal address

Resident in Khomas Region?

Yes No

E. Family

Learner lives with

Orphan / vulnerable status

Siblings already at this school (name & grade)

F. Medical & emergency

Allergies

Chronic conditions

Chronic medication

Medical aid scheme

Medical aid number

Immunised? (Y/N)

Emergency contact name

Emergency contact phone

G. Documents attached

Birth certificate Parent/guardian IDs Immunisation card Latest report Proof of residence Transfer letter Passport photos

H. Declaration

I declare that the information provided above is true and correct. I understand that this application is free of charge, that no screening or admission fees may be charged, and that learners residing in the Khomas Region receive first priority for placement.

Parent / guardian signature

Name in print

Date

Khomas Regional Council, Directorate of Education · Tel +264 61 292 4444 · pr@khomasrc.gov.na · Frans Indongo Gardens, Private Bag 13236, Windhoek · Admissions enquiries: Mr. Dumi M. Litwayi, +264 81 732 6609