Student Information
Name
*
Date of birth ddmmyy
*
/
Month
/
Day
Year
Gender
*
Female
Male
Other
Citizenship
*
Home Address
*
City
StateProvince
Country
Postal Code
IDPassport No
Email
example@example.com
Phone
Format: (000) 000-0000.
Parents Information
Mothers Name
Fathers Name
Mother Phone
Format: (000) 000-0000.
Father's Phone
Format: (000) 000-0000.
Mothers Email
example@example.com
Fathers Email
example@example.com
Grade Applied For (Tick One)
*
9
10
11
12
Previous School Attended
School Name
*
Date Attended From
*
-
Month
-
Day
Year
Date
TO
*
-
Month
-
Day
Year
Date
School Name
Date Attended From
-
Month
-
Day
Year
Date
TO
-
Month
-
Day
Year
Date
Future planned field of studies (mark all relevant)
*
Science
Engeenering
Business
Libral Arts - Specify
By Signing below you confirm that have read and agreed to abide by the code of conduct and terms and condition of enrolment
Student Signature
Date
/
Month
/
Day
Year
Date
Parent signature
Date
/
Month
/
Day
Year
Date
Please attach the following documents
Copy of Passposrt
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(First 2 pages)
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Copy of all academic transcript
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/ report cards form grade 9 onwards, in English
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of
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