PRELIMINARY ONLINE APPLICATION FORM

This is a preliminary form indicating your interest. Kindly complete and submit. You will be required to download, print, complete
and submit the application form to the Regional Office nearest you. Click here to download Undergraduate application form or here
for Postgraduate application form. All fields are required*.
Name*:
Gender / Sex*:
Male
Female
Nationality*:
Address Line 1*:
Address Line 2*:
Contact #*: (Work)
(Home):
(Mobile):
Email Address*:
Date of Birth*:
Marital Status*:
Single
Married
Divorced
Widowed
PROGRAMME INFO*: Please select from lists below.
Mode of Study*:
Part time
Full time
Pre IUC
Location of Study*:
DO YOU HAVE ANY DISABILITIES*:
Yes
No
EDUCATIONAL BACKGROUND*:
INSTITUTION
CERTIFICATION
DURATION (SPECIFY YEARS)