Chalimbana Local Government Training Institute
(Diploma Programme Application Form)
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
+260
Phone Number
NRC Number
*
Chalimbana Local Government Training Institute
Gender
*
Please Select
Male
Female
Date of Birth
*
DD-MM-YYYY
Marital Status
*
Please Select
Single
Married
Divorced
Secondary School/Institution Attended. (Give dates.)
*
Residential Address
*
Postal Address
Name, Address and Telephone Number(s) of next of Kin.
*
Do you have any physical or communication disabilities? if yes please tick.
Vision
Mobility
Speech
Hearing
Other
Which Programme are you applying for?
*
Diploma in Local Government Finance
Diploma in Local Government Administration
Diploma in Rural and Urban Management
Fill in this part if you are presently employed. (Type of employment, name of employer, address of employer and period of service.)
Upload Proof of Payment
*
Upload a File
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Choose a file
Cancel
of
Upload the following: 1. NRC/Passport 2. Grade 12 Certificates 3. Any other Certificate etc.
*
Upload a File
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Cancel
of
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