Graduation * Select Primary Certificate Pre-School Certificate

Select Course * Select SD_Baby Class SD_Middle Class SD_SD_Reception Class SD__SD_Grade 1 SD_SD_Grade 2 SD_Grade 3 SD_Grade 4 SD_Grade 5 SD_Grade 6 SD_Grade 7

First Name *

Gender * Select Male Female

Date of Birth *

Name of the campus *

Name of Course and Year

Address while studying *

Subjects (List them below)

Higher grade

Standard grade

Year attended from:

Year attended to:

Province

Name of School

School Address

Have you ever been found guilty of the criminal offence?
Yes    No

If yes , specify the nature and date of offence

Zambian citizenship
Yes    No

Identity Number

Do you suffer form any chronic diseases?
Yes    No

If YES , explain about your diseases.

Are you physically challenged
Yes    No

If you are physically challenged (explain your disabilities)

Payment Mode

Deposit slip

Documents (To upload multiple document compress it in a single file then upload it)