Falds Registration Form
Fill out the form carefully
Learner Details
*
First Name
Middle Name
Last Name
Identity Number
*
Gender
*
Please Select
Male
Female
N/A
Disabilities
Please Select
YES
NO
If YES specify disability in Comments section
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Number
*
Other Number
*
E-mail
example@example.com
Courses
*
1. Cashier ONLY
1.1. Cashier and Computer
2. Office Administrator
3. Call Centre Agent
4. Bookkeeping
5. Payroll Administrator
6. HIV/TB Counseling and Testing
7. Care Giver / Home Based Care
8. NIMART
8.1. NIM DR TB
9. Phlebotomy Technician
10. End User Computing 2 Weeks
10.1. End User Computing 4 Weeks
10.2. End User Computing 8 Weeks
10.3. End User Computing 12 Weeks
11. Good Clinical Practice (GCP)
12. Hospitality / Chefs / Cooks
Start Date
-
Day
-
Month
Year
NB: Confirm time before reporting for class!
Class Options
*
Please Select
*Full-time Mondays - Thursdays
*Part-time During the week/Saturdays
*Online via Zoom or WhatsApp - Mondays - Thursdays
*Distance Learning/Home Study
Signature
*
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