Director Certification
       Application Form for Provider
           Approval, Qualification
     Recognition and CPD programme
                  evaluation
        
       This form is completed as per the Guidelines on approval of activities 
       contributing toward the Career Path or CPD for Director Certification.
       There are 2 sections to this form:
       Section 1: This section is only completed once and applies to the applicant 
       institution or organisation.
       Section 2:  This section is completed for each activity or intervention for which 
       approval is sought.  The applicant simply needs to copy and paste this section for
       each activity or intervention. Both parts of this section need to be completed for 
       each activity or intervention. Additional information can accompany the 
       application as separate documents.
                  Section 1: Institution or Organisation
                  This section needs to be completed by every institution or organisation applying for approval.  
                  Please ensure that all relevant information is provided.
                  Name of Institution / 
                  Organisation
                  Website address (of 
                  programme applying for)
                  Postal Address
                  Company 
                  registration no (if 
                  applicable)
                  VAT number (if 
                  applicable)
                  Status of Institution    Accredited HEI or training            Yes / No
                  or Organisation          provider?
                                                                                 Reg number:
                                           Registered with DHET?                 Yes / No
                                           SETA / QCTO / CHE                     SETA / QCTO / CHE
                                           accreditation?
                                           Recognized professional               Yes / No
                                           body?
                                                                                 SAQA number:
                                           Other
                                           Please describe
                  Reason for               Recognised Qualification
                  application
                                           Approved CPD Programme
                  Name of contact          Title 
                  person 
                                           Name 
                                           Surname 
                                           Designation / 
                                           Job Title
                  Contact details          Office no.:
                                           Mobile:
                                           Email:
              Section 2: Activity or Intervention
              2.1 Description of Activity or Intervention
              Complete a separate table for each activity or intervention included in this application. The application 
              may be supported with detailed content, presentations, learning material etc to facilitate an accurate 
              CPD point allocation.
              Name of activity or 
              intervention 
              Date and programme of
              activity or intervention
                                       Full qualification            SAQA ID
              Type of activity or      Short learning programme (SLP)
              intervention
                                       Workshop, seminar, conference
                                       2 days or          3 days           Full 
              Duration                                    or 
              (please tick)            less                                qual.
                                                          more
              Mode of delivery         Face to            Online           Hybrid
                                       face
              Outline of activity or 
              intervention (attach 
              brochure or webpage 
              printout)
              For full qualification 
              approval, provide 
              comprehensive list of 
              outcomes and content
              Name(s) of facilitators 
              or lecturers 
              (attach CVs)
              Target audience
              Assessment (Y/N)
              Type of assessment 
              (describe)