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Evergreen Application Form

Application form

Uploaded by

Brian Besa
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
116 views2 pages

Evergreen Application Form

Application form

Uploaded by

Brian Besa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application No………………….…….

FOR OFFICIAL USE ONLY:


Batch No……………………………….
RECEIPT NO……………………………………
Data entered by……………………….
DATE OF RECEIPT OF COMPLETED APPLICATION
FORM……………………………………………...

RECEIVED BY……………………………………

KNOWLEDGE FOR GROWTH

EVERGREEN COLLEGE-ZAMBIA
PLOT NO. 94 KALUNGWISHI STREET, NKANA EAST
P.O. BOX 20716-KITWE, ZAMBIA
CONTACT DETAILS: Cell: 0965832431/0967614256/0974882216/0953469194

Email: evergreenschools@gmail.com
APPLICATION FORM FOR ADMISSION TO ACADEMIC SCHOOLS
CATEGORY OF APPLICANT FULL TIME PART TIME EVENING WEEKEND DISTANCE

STUDENT ID NO.#

1.0 PERSONAL DETAILS

SURNAME
MIDDLE NAME
FIRST NAME
DATE MONTH YEAR
2.0 SEX MALE FEMALE 3.0 DATE OF BIRTH

4.0 MARITAL STATUS


MARRIED SINGLE OTHER (SPECIFY) …………………………………………………

5.0 NATIONAL IDENTIFICATION NO.

IF NON ZAMBIAN PASSPORT NO. PLACE OF ISSUE……………………….

NATIONALITY……………………………………………………………………..

6.0 CONTACT DETAILS

LAND LINE NO………………………………………………………… CELL NO…………………………………………………………….

P.O BOX…………………………………………………………………. FAX…………………………………………………………………..

7.0 RESIDENTIAL ADDRESS

HOUSE NO.
STREET NAME
RESIDENTIAL AREA
TOWN
COUNTRY

8.0 NAME OF PARENTS/GUARDIANS OR NEXT OF KIN……………………………………………………………………………………….

ADDRESS…..………………………………………………………………….…………………………………………………………………………….

KNOWLEDGE FOR GROWTH


CELL NO:…………………………………………………………………………………………………...………………………………………………….

9.0 LAST SECONDARY SCHOOL ATTENDED

SCHOOL NAME…………………………………………………………………………………………….

TOWN/CITY…………………………………………………ROVINCE………………………………COUNTRY…………………………………
10.0 GCE/SC ORDINARY LEVEL RESULTS (ATTACH TRANSCRIPT)

CODE SUBJECT GRADE CODE SUBJECT GRADE

11.0 A-LEVELS ATTENDED

SUBJECT RESULTS EXAMINATION BODY

1 ……………………………………………………………………………………………………………………………
2 ……………………………………………………………………………………………………………………………
3 ……………………………………………………………………………………………………………………………

4 ……………………………………………………………………………………………………………………………

12.0 LAST EDUCATION INSTITUTION ATTENDED

NAME………………………...………………………………………………………………………………………………………….

QUALIFICATION OBTAINED……………………...…………………………………………………………………………..

13.0 CHOICE OF COLLEGE PROGRAM

FIRST CHOICE………………………………………………………………………………………………….

SECOND CHOICE…………………………………………………………………………………………….

14.0 DO YOU HAVE ANY PHYSICAL OR COMMUNICATION DISABILITIES


YES
NO
IF YES SPECIFY

15.0 ARE YOU PRESENTLY EMPLOYED

IF YES TYPE OF EMPLOYMENT………………………………………………………………………………


NAME OF EMPLOYER………………………………………………………………………………….

ADDRESS OF EMPLOYER……………………………………………………………………………..
PERIOD OF EMPLOYMENT………………………………………………………………………….

16.0 DECLARATION

I DECLARE THAT THE INFORMATION PROVIDED BY ME ON THIS FORM IS CORRECT AND COMPLETE.
I AUTHORISE EVERGREEN INSTITUTE TO RESERVE THE RIGHT TO WAIVER OR REVERSE OF ADMISSION
MADE ON THE BASIS OF INCORRECT OR INCOMPLETE INFORMATION

KNOWLEDGE FOR GROWTH


_________________________ ______________________________
SIGNATURE OF APPLICANT DATE OF SUBMISSION

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