RIVERBANK ACADEMY

Application Registration Form

Fill out the form carefully for registration
Part 1 : Program
Program*
Program*
Specialization:e.g Finance,Human Resource,Logistics
Application status*

New
Part 2 : Personal Information
Student Name as per IC/Passport*

Family NameLast Name
Birth Date*

MonthDayYear
Gender*
Marital Status*
Identity Type*
NRIC Number*
Passport Number*
Nationality*
Immigration pass expiry date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address*
example@example.com
Mobile Number*
Part 4 : Academic Qualifications
Academic Qualifications*
Part 3 : Emergency Contact
Name*
Relationship
Contact Number*
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Part 5 : Others
Where did you learn our programs?*

AdvertisementPersonal recommendationWebsite / Social mediaOpen DaySchool eventPublic education fairAgent/Recommender
Do you have any medical condition that needs attention?

No. I hereby declare that I am physically and mentally fit and there is no other medical condition or disability likely to prevent me or require special attention or care in relation to my study with Riverbank AcademyYes.
Please Provide Details
Part 6 : Document Checklist
Document checklist for Malaysian applicants*
File Upload*

Cancelof
Part 7 : Student's Declaration
I declare that the information provided by me in this application form is true and correct. I acknowledge that RIVERBANK ACADEMY reserves the right to vary or reserves any decision regarding admission or enrolment made regarding the basis of incorrect or incomplete information.
Signature of applicant*

Clear
Should be Empty:

Application Registration Form

Part 1 : Program

Part 2 : Personal Information

Part 4 : Academic Qualifications

Part 3 : Emergency Contact

Part 5 : Others

Part 6 : Document Checklist

Part 7 : Student's Declaration