Empowering the youth through technology

applications@impactschool.org.ls

+266 6281 8022

Application Form

Page 1 of 2

1.

Student Information

Full Name

Date of Birth

Gender

Nationality

ID / Passport Number

Physical Address

Email Address

Phone Number

2.

Program Selection

Choose Program

IoT Python Programming Web Development

Select Intake

3.

Educational Background

Last School Attended

Highest Qualification

4.

Parent & Guardian Information

This section is required for students under the age of 18

Full Name

Relationship to Applicant

Mobile Number

Email Address