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
2 digit month, 2 digit day, 4 digit yearDate
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
2 digit month, 2 digit day, 4 digit yearDate
SECTION 3: ACADEMIC BACKGROUND
Highest Qualification:
Institution:
Year of Graduation:
Intake:
SECTION 5: FINANCIAL INFORMATION
Estimated Budget (USD):
Interested in Scholarship:
(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:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
FOR ICAI OFFICIAL USE ONLY
Student Reference Code:
Admissions Officer:
Date Received:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Remarks:
ICAI Official Stamp & Signature:
Should be Empty: