# Student Registration

## Student / Learner Details

Name Surname Gender
Male Female Other
Date of Birth (yyyy/mm/dd) Phone Number Email Address Physical Address Home Language Upload Latest Results Upload ID

## Academic Information

Program Registering Grade / Level Curriculum
Learning Mode
Subject(s)
Name of School

## Next of Kin 1 Details

Name Surname Personal Contact Work Contact Email Address Physical Address Relation to Student Occupation Home Language

## Next of Kin 2 Details

Name Surname Personal Contact Work Contact Email Address Physical Address Relation to Student Occupation Home Language
Where did you hear about us?
Please specify
Additional Notes