Course Registration Form

* All fields marked with asterisks (*) are required to complete the application

Personal Details

Surname *

First Name *

Middle Name (leave blank, if not available)

Phone/Mobile No. *

Email Address *

Verify Email Address *

Citizenship *

City/Town/Suburb *

State/County *

Course Details

Name of course applying for: *

Academic Qualification *

At least, a high school certificate is required. Use the fields below to upload your past academic experience. If you do not have a high school certificate ready, click here to give a brief explanation on why you don't have one yet.

institution Attended *	certificate Attained *	From - To Year *	grade Attained *	Upload Cert *

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In one or two paragraphs, tell us why you need financial support*
*Note: You might be required to provide more evidence of financial need from authorities(e.g. Dean or registrar, chief, MCA, MP or Women Rep) later on

Additional Information & Declaration

Declaration *

I confirm that the information I have given herein is correct and that I have read the rules and regulations.

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Quick Links

Programs

Contacts

P.O. Box 570 - 50307,
Luanda, Kenya

+254770827208

admissions@western-institute.com

https://elearning.western-institute.com

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