Section 1 Surname (required) First Name (required) Your Email (required) Address (required) Date of Birth Sex MaleFemale Tel. No. Tel. No. Cell Do you have any permanent health problems? (e.g asthma, epilepsy, partial deafness, blurred vision, migraines, sinus). If so, PLEASE GIVE DETAILS. Upload Photo Here
Section 2 Name of Parent/Guardian/Sponsor Address of Parent/ Guardian/ Sponsor Email Address Tel. No. Tel. No. Cell
In case of emergency contact Surname (required) First Name (required) Address (required) Tel. No. Tel. No. Cell
Section 3 Educational History CXC 'O' & 'A' Levels, Cape subjects passed/attempted to date (Each Subject on a new line) Example: 2017-2018, Name of School, C.X.C Mathematics, Grade 2
Section 4 Duration of Course Sept-May/JuneSept-JanFeb-JanVacation Course Times MorningAfternoonEveningSaturday
Section 5 Subjects Offered C.X.C./C.S.E.C O' LEVEL Additional MathematicsChemistryEconomicsEnglish-AGeographyHuman and Social BiologyMathematicsPhysicsPrinciples of AccountsPrinciples of BusinessSocial StudiesSpanish C.A.P.E A' LEVEL AccountingEconomicsEntrepreneurshipLawBusiness StudiesSociologyCaribbean StudiesCommunication Studies Other desired subjects not offered at Elders' Classes
Section 6 Payment C.X.C./C.S.E.C Number of Subjects and Cost Example: 1 Subject = $2,400.00TTD, 2 Subjects = $4,800.00TTD, 3 Subjects = $7,200.00TTD ---2400.004800.007200.008800.009800.0010000.00 Cape A'Level Number of Subjects and Cost Example: 1 Subject = $2,500.00TTD, 2 Subjects = $5,000.00TTD, 3 Subjects = $6,000.00TTD ---2500.005000.006000.00 G.P.F Example C.X.C./C.S.E.C = $200.00, Cape A'Level = $300.00 200.00300.00 Total [calculator calculator-919 Prefix:$ Precision:2 "menu-100 + menu-300 + menu-715"]
Section 7 Where did you hear about us?FacebookInstagramWebsite Other
