PLEASE COMPLETE IN CAPITAL LETTERS

REGISTRATION DETAILS
Short Course you are applying for*
APPLICANT'S DETAILS
First Name*
Surname*
NIN*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Home Tel*
Mobile*
Work Tel*
Personal Email Address *
Cannot be same as work email
Complete Address*
Employment Sector*

GovernmentPrivate CompanyOn AHRD ScholarshipUnemployed
NEXT OF KIN (TO BE CONTACTED IN CASE OF EMERGENCY)
Full Name*
Relation*
Mobile*
Work Tel
Home Tel
EMPLOYMENT DETAILS
Company Name
Companys Complete Address
Work Mobile
Work Tel
Work Email
example@example.com
DETAILS OF SPONSOR
Who Will Be Paying For Your Course?*

WorkplaceSelf-funding/ other Sponsor
Please state billing address
Please state any relevant disability/ medical condition/ allergy/ dietary restriction you would like to share with the University*
APPLICANT'S CHECKLIST AND DECLARATION

1. A copy of their NIN/ID card or passport.

2. Payment of the non-refundable application processing fee of SCR300 (if applicable)

Important: Your application will be processed only if you have submitted a complete application, required documents and the application processing fee if required.

I certify that all the information given above is true.
ID Card or passport photo*

Cancelof
Applicants Full Name*
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty: