Application form S1-S3
 
  * Fields are mandatory
  * This section is mandatory
     
  Last name:
  First name:
  SAPIK registration number:
  E-mail address:
  Date of application:
     
   
 

Complete this section if you are presenting an information session or group discussion (S1)

The application must be accompanied with the programme and the information (power point, pamphlet etc.) which will be presented. Application should reach SAPIK at least one month before the information session or group discussion will take place.

   
  Please complete the fields below:
     
  Place and Venue:
  Target group:
  Title of information session/group discussion:
  Date of information session/group discussion:
  Time and duration of information session/group discussion:
     
   
 

Complete this section if you are attending a learning activity (S2)

The application must be accompanied with the activity and the relevant information (pamphlet, advert etc) of what the learning activity will consist of. Application should reach SAPIK before or within the month after the learning activity take place.

   
 
     
  Section (accredited workshop, congress, group discussion etc.):
  Organisation/institution/person presenting the learning activity:
  Place and Venue:
  Title of learning activity:
  Date of learning activity:
  Time and duration of learning activity:
  Is the learning activity a HPCSA accredited activity?:
  If you said yes on the above question, indicate the CEU points allocated by the HPCSA:
  Registration fee (if applicable):
     
   
 

Complete this section if you are completing individual learning or educational activities (S3)

After the activity is completed the Application form must be completed. Take note: information session, publications in magazines, TV conversations etc. first need to be approved by SAPIK and therefore a S1 form must be completed beforehand

The application must be accompanied with the relevant proof (certificate, proof of publication etc).

   
 
     
  Section (degree, publication, examination etc):
  Organisation/Institution/Journal:
  Date of completed activity:
  Years conducting activity (if applicable):
     
  Please Upload The Required Documents:
 
   
 
 
   
 
 
   
  Signature:
 
   
  Date:
  --
   
 
Security Check: