INSTITUTE FOR CYBERSECURITY & AI (ICAI)PROSPECTIVE STUDENT INTAKE FORM

INSTITUTE FOR CYBERSECURITY & AI (ICAI)PROSPECTIVE STUDENT INTAKE FORM

Fin Goudron, Ecole Publique New Deido, Douala Cameroon
SECTION 1: PERSONAL INFORMATION
Full Name (as per passport):*
Date of Birth:*

MonthDayYear
Date
Age:*
Gender:*
Nationality:*
Phone (WhatsApp):*

Area CodePhone Number
Your Official Email: (This will be most reliable channel of communication, so please get a valid Email address)*
example@example.com
SECTION 2: PASSPORT DETAILS
Passport Number:
Country of Issue:
Expiry Date:

MonthDayYear
Date
SECTION 3: ACADEMIC BACKGROUND
Highest Qualification:*
Institution:*
Year of Graduation:*
MarchMayJulySeptemberNovemberJanuary Year:
SECTION 5: FINANCIAL INFORMATION
Estimated Budget (USD):
YesNo
(5% off IF YOU PAY IN ONE INSTALLMENT)
Purpose ?*
Why are you interested in this program? Work, Appy for Work Visa, Immigrate, Career improvement....
DECLARATION
By Signing and Dating this form, I declare that the information provided is true and accurate to the best of my knowledge. ICAI or our partners will assume zero liability in cases of fraudulent documents and or intentioanlly providing wrong information.
Student Name:*
Signature:*

Clear
Date:

MonthDayYear
Date
FOR ICAI OFFICIAL USE ONLY
Student Reference Code:
Admissions Officer:
Date Received:

MonthDayYear
Date
Remarks:
ICAI Official Stamp & Signature:

Clear
Should be Empty: