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KASTINA EMPOWERMENT ENROLLMENT
KATSINA EMPOWERMENT REGISTRATION FORM
First Name
Last Name
Phone Number
Email
Date of Birth
Gender
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Male
Female
Address
Address
LOCAL GOVERNMENT AREA
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Bakori
Batagarawa
Batsari
Bindawa
Baure
Charanchi
Dandume
Danja
Dan-Musa
Daura
Dutsinma
Dutsi
Faskari
Funtua
Ingawa
Jibia
Kafur
Kaita
Kankia
Kankara
Katsina
What is your highest level of qualification
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Primary Education
Secondary
Technical College
National Diploma
University Degree
Master Degree
Vocational Education
Can you dedicate 2 to 3 hours daily for this training
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Yes
No
Are you computer literate?
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Yes
No
Are you a person with Disability?
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YES
NO
What is your Disability?
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Deaf (Hearing Impaired)
Blind (Visual Impaired)
Albino
Dwarf
Others
Interests
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ICT
Culinary
Agriculture
Fashion Design
What part in ICT?
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Data Processing
Graphics Design
Website Development
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