Online Application

Learner Application Form

First name:

Surname:

Other name:

Date of birth:

LIN:

Gender:

Orphan:

Current class:

Farmiliar language:

District of birth:

Special needs:

Health needs:

Talents:

Practical skills:

Religion:

Address:

Carrier:

Former school:

Previous performance:

Passport photo:

Parent1 name:

Parent1 NIN:

Parent1 Job:

Parent1 Contact:

Parent1 Contact2:

Parent1 email:

Parent1 Maritalstatus:

Parent1 religion:

Parent1 relation:

Parent2 name:

Parent2 NIN:

Parent2 Job:

Parent2 Contact:

Parent2 Contact2:

Parent2 email:

Parent2 Maritalstatus:

Parent2 religion:

Parent2 relation:

Kin name:

Age:

Kin relation:

Kin contact1:

Kin contact2:

Kin NIN:

Knew us:

Referral code: