Joren Buijs selected to represent the Netherlands U18 Rugby Team |

UXI Sport 2024 STUDENT FINANCE APPLICATION

"*" indicates required fields

Step 1 of 4

Rugby Institute Selection

Rugby Programme interested in?*

Men's Rugby Programme

Women's Rugby Programme

Which Institute is the player applying to?*

Western Province Rugby Academy

Cheetahs Institute of Excellence

Pumas Rugby Institute

Griquas Rugby Institute

Harlequins International Rugby Institute

Limpopo Blue Bulls Rugby Institute

Documents to upload

Latest School Results*

Max. file size: 2 MB.

Proof of leadership (general/sport)*

Max. file size: 2 MB.

Proof of sport/s team/s and tournament participation*

Max. file size: 2 MB.

Letter of motivation from coach/school*

Max. file size: 2 MB.

Proof of cultural participation*

Max. file size: 2 MB.

Parents Details

Name*

First Last

Date of Birth*

ID Number*

Cell

Email

Physical Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouse’s Details

Name*

First Last

Cell Phone No:*

Tel. Phone No:*

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who will be responsible for the Player/Student account? Tick the relevant option.*

Parent 1

Parent 2

Both

Sponsor

Contact Details of a Person NOT Residing with You

Name*

First Last

Relationship*

Cell Phone No*

E-mail Address*

Parent/Guardian/Sponsor Information

Parent/Guardian/Sponsor 1

Current Employer*

Employer Contact No*

No. of months at Current Employer*

Gross Monthly Income*

Designation/Employee Number:*

Summary of Monthly Expenses

Bonds/Rent*

Groceries*

Vehicles*

Utilities*

Vehicles*

Clothing*

Education*

Household*

Maintenance*

TOTAL EXPENSES:*

Parent/Guardian/Sponsor 2

Current Employer*

Employer Contact No*

No. of months at Current Employer*

Gross Monthly Income*

Designation/Employee Number:*

Summary of Monthly Expenses

Bonds/Rent*

Groceries*

Vehicles*

Utilities*

Clothing*

Education*

Household*

Maintenance*

TOTAL EXPENSES*

Consent

AGREE / NOT AGREE to a Credit Bureau Assessment.*

Yes

No

Signature*

Parent Declaration

Please take note of the following:

1. The options selected allows UXi Rugby Institutes to tailor make a financial plan that suits you. The Academic Programmes are offered at an additional cost as indicated in the Edu Boost option selected as well as the additional services. You may ADD services at any time by contacting our finance department.
2. During the 1st three weeks of Orientation in February 2024 the players will be required to register directly with the Education Provider selected. The players will also be offered FREE career guidance tests during this period. Every player must ensure that they have their latest certified copy of their school results and ID documents and/or Birth certificate.
3. Application for loans towards a financial institution will require a *Provisional Admissions Acceptance letter.
4. Please note you cannot receive the bursary price indicated on the brochures for the Education option, if not fully registered as a UXi Sport Rugby Institute player first.
5. *FOREIGN STUDENTS: All foreign students will be required to make full cash payment upfront before letters for the relevant Embassy will be issued for a VISA and or study permit.
6. In respect of the Protection of Personal Information (POPI) Act 2013: the Applicant confirms that he/she understands that the purpose for the collection and/or distribution of his/her personal information is to conclude their successful application into the UXi Rugby Institutes.
*Please note that prices are subject to increase as of the 1st of January 2024.

Parent’s Full Name*

First Last

By placing your name in the above block, you confirm that this is your electronic signature, and that this information is true and legally applicable.

Signed on this day*

Parent’s Signature*

Programme	Duration	2024 Fees		Deposit	Once-off Registration Application fee
		Cash	Terms/Monthly	*Payable before 31/12/2023	*Non-refundable

High Performance Rugby Player Development Programme	12 months	R64 000	R70 400 (12 x R4 617)	R16 000	R1 950
	6 months	R36 000	R39 600 (7 x R4 228)	R11 000	R1 950
International Bridging Programme: Rugby Player Development	6 months	R39 900	R42 800 (7 x 4 257)	R13 000	R1 950
University/Scholarship Bridging Programme: Rugby Player Development	6 months	R39 900	R42 800 (7 x R4 257)	R13 000	R1 950
On-Field Rugby Coach & Internship Programme *Includes National and International accredited Certification programme books & courseware	12 months	R63 000	R69 300 (12 x R4 525)	R15 000	R1 950
Rugby Strength and Conditioning Coach & Internship Programme *Includes National and International accredited Certification programme, books & courseware	12 months	R63 000	R69 300 (12 x R4 525)	R15 000	R1 950
Video and Game Analyst & Internship Programme *Includes National Provider programme, certification, books & courseware	12 months	R48 000	R52 800 (12 x R3 233)	R14 000	R1 950
Top-Up Clothing kit	N/A	R4 000	N/A	N/A	N/A

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UXI Sport 2024 STUDENT FINANCE APPLICATION

Rugby Institute Selection

Documents to upload

Parents Details

Spouse’s Details

Contact Details of a Person NOT Residing with You

Parent/Guardian/Sponsor Information

Parent/Guardian/Sponsor 1

Summary of Monthly Expenses

Parent/Guardian/Sponsor 2

Summary of Monthly Expenses

Consent

Rugby Career Options

*ADD on an Education “Edu-Career Boost” Package to your Programme:

EDU-BOOST 1

EDU-BOOST 2

EDU-BOOST 3

Parent Declaration

Please take note of the following:

Section Break

2024 REGISTRATION APPLICATION FORM

ADDITIONAL STUDY OPTIONS

Player’s Details

Request a quote for your chosen “Edu-Career Boost” Option:

HFPA Fitness Academy Programmes

IMM Graduate School Programmes

Africa Skills Village (ASV) Programmes

TestOut Programmes

Notes & Declaration

Please take note of the following:

Player Declaration

Parent Declaration

Page Break

JUNIOR ACADEMY REGISTRATION FORM

Player’s Details

Rugby Institute Selection

Medical and Training History

Rugby, Schooling Career and Literacy Information

Parent/Guardian/Sponsor Information

Parent/Guardian/Sponsor 1

Parent/Guardian/Sponsor 2

Notes & Declaration

Please take note of the following:

Player Declaration

Parent Declaration

Page Break

JUNIOR RUGBY ACADEMY FINANCE APPLICATION

Player’s Details

Rugby Institute Selection

Parent/Guardian/Sponsor 1's Details

Parent/Guardian/Sponsor 2's Details

Contact Details of a Person NOT Residing with You

Financial Information

Parent/Guardian/Sponsor 1

Summary of Monthly Expenses

Parent/Guardian/Sponsor 2

Summary of Monthly Expenses

Consent

Junior Rugby Academy Financial Plan

Parent Declaration

Please take note of the following:

Section Break

PART TIME ACADEMY REGISTRATION FORM

Player’s Details

Rugby Institute Selection

Medical and Training History

Rugby, Schooling, Career and Literacy Information

Parent/Guardian/Sponsor Information

Parent/Guardian/Sponsor 1

Parent/Guardian/Sponsor 2

Notes & Declaration

Please take note of the following:

Player Declaration

Parent Declaration