The MUC School of Continuing Studies Application Form

The Mico University College

School of Continuing Studies Application Form for Professional Development/Up-Skilling Short Courses, Programmes & Workshops
SECTION A - PERSONAL DATA
Name*

TitleFirst NameMiddle InitialLast Name
Please enter your TRN or National ID Number*
for example 123-456-789
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Date of Birth*

DayMonthYear
DD/MM/YYYY
Permanent Address*

Street Address

Street Address Line 2

Parish/CityState / Province

Postal / Zip Code
Mailing Address (if different from permanent address)

Street Address

Street Address Line 2

Parish/CityState / Province

Postal / Zip Code
Have you previously been a student at The Mico?*

YesNo
Identification (ID) Number*
Please enter your ID number
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Programme Studied

Please enter all Tertiary Programmes that you have completed or currently pursuing (if any)

The Mico University College