New Student Registration Form

Student's Full Names:

Date of Birth (YYYY-MM-DD).

Gender:
MaleFemale

Student's Email Address: (required)

Telephone No:

Place of Residence (County, sub-county, Location, etc)

Course(s) to take

Intake:

JanuaryMaySeptember

Part timeFull TimeEveningsWeek-endsOnline

Name of person paying fees

Relationship

Telephone Number

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