Learner Admission Form
Pupil's Name
First Name
Last Name
Pupils Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Nationality
Gender
Please Select
Male
Female
Residential Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of current school
Current Grade
Learner/Student Number
Last school result
Promoted (passed)
Failed
Last school result term
Do you require financial aid/sponsorship?
Local Guardian Name
First Name
Last Name
Local Guardian Occupation
Local Guardian Email
example@example.com
Local Guardian Phone Number
Please enter a valid phone number.
Attach certified copy of Latest School Results
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Attach copy of Parent/Gurdian ID
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Attach copy of Learner Birth Certificate/Identity Document
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Should be Empty: