Applcation Form

Course applying for : *

Year applying for : *

PART A: PERSONAL INFORMATION

PrefixMr.Mrs.Ms.MissDr.Prof.

First Name *

Last Name *

Passport / NIC Number : *

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Passport / NIC *

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Please upload the Passport / NIC

Date of Birth *

MonthSelect month123456789101112

DaySelect day12345678910111213141516171819202122232425262728293031

YearSelect Year212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Age : *

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Copy of the Birth Certificate *

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Please upload the Birth Certificate

Civil Status : *SingleMarried

Street Address : *

City :

State/Province :

ZIP / Postal Code :

Residence Phone Number : *

Mobile Phone Number : *

Email Address : *

Employment Details *StudentEmployer

PART B: EMPLOYMENT DETAILS

Designation :

Official Address

Telephone Number :

Official Email Address :

Employment Letter / Service Letter

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Please upload the Employment Letter / Service Letter

ACADEMIC QUALIFICATION

School Attended : *

G.C.E. Advanced Level *

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G.C.E. Ordinary Level *

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Higher Education / Professional Qualifications

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Please upload the Higher Education / Professional Qualifications Documents

PERSON TO BE CONTACTED IN A CASE OF EMERGENCY

PrefixMr.Mrs.Ms.MissDr.Prof.

First Name *

Last Name *

Relationship to Student : *

Telephone Number *

AWARENESS ON IIHS PROGRAMMES

How did you get to know about our Programmes? (Select from the followings) *

(Agent, Advertising Boards at IIHS, Brochures, Banners/Posters, Education Fair/Exhibition, E-mail, E-adds, Google, IIHS Student, IIHS Website, News paper advertisements, Radio, TV programmes/Commercials, Others)

If others, please specify *

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