Online Admission Form

Basic Details

Graduation *

Select Course *

Section *

First Name *

Last Name *

Gender *

Date of Birth *

Mobile Number *

Email *

Passport Size Photo

Blood Group

Name of the campus *

Name of Course and Year

Address while studying *

Previous School Details

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

Parent Details

Father Name

Father Phone

Father Occupation

Passport Size Photo

Mother Name

Mother Phone

Mother Occupation

Passport Size Photo

Guardian Details

If Guardian Is * Father Mother Other

Guardian Name *

Guardian Email

Passport Size Photo

Guardian Phone

Guardian Occupation

Guardian Address

Bank Details

Bank Name

IFSC Code

Upload Documents

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