SkYE Registration Form
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Zone *
First Name *
Middle Name
Last Name *
Address
Date of Birth *
MM
/
DD
/
YYYY
Telephone Number
E-mail Address
Next of Kin
Next of Kin Address
Next of Kin Phone Number
Marital Status *
Employment Status *
Highest Education Level Attained
Clear selection
Certificates Obtained
Will any of the following circumstances prevent you from attending training regularly? *
Required
Do you have any children? *
If yes, how many do you have?
Clear selection
Are you currently enrolled in any other programs? *
If yes, specify
Are you receiving any assistance? *
If yes, specify
Personal Challenges *
No difficulty
Some Difficulty
Lots of Difficulty
Do you have difficulty seeing, even if wearing glasses?
Do you have difficulty hearing, even if using hearing aid?
Do you have difficulty walking or climbing steps?
Do you have difficulty remembering or concentrating?
Do you have difficulty with self-care, such as, washing all over or dressing?
Programs Offered *
*Will be updated as programmes are confirmed
Submit
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