• Personal Data
  • Educational Information
  • Other Information

Personal

Surname

First Name

Middle Name

Birth Date

Place of Birth

Mailing Address

Permanent Home Address

Student's Email Address

Student's Phone Number

Parent's Email Address

Parent's Phone Number

Name of Parent/Guardian/Sponsor

Address of Parent/Guardian/Sponsor

Name of Next of Kin

Address of next of Kin

Desired Subject Combination

Subject 1

Subject 2

Subject 3

Schools Attended

Name of School

Address of School

Admission No

Favorite Teacher

Friends in School

From

To

Examination Result

Examination

Date

Centre

Exam Number

Are you awaiting any result?

First Choice Course

Second Choice Course

When do you intend to write exam?

Medical History

Do you have any ailment?

If yes, kindly state ailment and frequency of occurrence

Family or Personal Doctor

Doctors Address

Doctors Phone Number

How did you hear about Educational Advancement Centre (Please tick one)

Others Specify

What are your future goals after completing your programme with us