Online Application Form – Africa Digital Media Institute

INTAKE PERIOD *

FIRST NAME *

LAST NAME *

EMAIL *

PHONE *

DATE OF BIRTH *

ID/PASSPORT NUMBER *

RESIDENCY DOCUMENTS *

Click or drag a file to this area to upload.

Please upload a copy of your ID/Passport/Birth certificate

GENDER *

HOME ADDRESS *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

IS YOUR CURRENT RESIDENCE SAME AS YOUR HOME ADDRESS? *

YOUR CURRENT RESIDENCE ADRESS *

Address Line 1

City

State / Province / Region

PASSPORT PHOTO(White or Clear Background) *

Click or drag a file to this area to upload.

Please upload a current passport photo. Please make sure it's taken against a plain background.

EDUCATION BACKGROUND

PREVIOUS INSTITUTION ATTENDED 1 *

Please indicate the year of completion and qualification attained in the following format. Institutional name/year/qualification.

PREVIOUS INSTITUTION ATTENDED 2

Please indicate the year of completion and qualification attained in the following format. Institutional name/year/qualification.

PREVIOUS INSTITUTION ATTENDED 3

Please indicate the year of completion and qualification attained in the following format. Institutional name/year/qualification.

PREVIOUS INSTITUTION ATTENDED 4

Please indicate the year of completion and qualification attained in the following format. Institutional name/year/qualification.

EDUCATION HISTORY EVIDENCE *

Click or drag files to this area to upload. You can upload up to 10 files.

Please upload all your education certificates, results slips, or transcripts from previous education.

ADMISSION CRITERIA

Diploma applicant: KCSE grade of C- and above with a C- and above in Kiswahili and/or English. Certificate applicant: KCSE grade of D and above.

I AM APPLYING FOR *

Please select the course you are applying for. Use the down and up arrow keys to select, press enter to confirm your choice.

YOUR MOTIVATION *

Please tell us why you are interested in taking this course. What are your motivations and what would you like to achieve after completion?

ARE YOU SELF SPONSORED?

GUARDIAN/PARENT DETAILS

Name *

First

Middle

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

IS THIS PERSON YOUR EMERGENCY CONTACT?

EMERGENCY CONTACT

Name *

First

Last

Email

Phone *

SPONSOR DETAILS (If different from parent or self)

Name

First

Middle

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

HOW DID YOU HEAR ABOUT US

ADMI ALUMNUS

Please provide the name of the alumnus.

ADMI STUDENT

Please provide the name of the student.

ADMI STAFF

Please provide the name of the staff member.

OTHER CHANNELS *

PLEASE PROVIDE MORE DETAILS IF OTHER *

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by the institution's regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this Institution. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission, and invalidation of credit or certificates earned. If admitted, I agree to abide by the policies of the Board of ADMI and the rules and regulations of the institution. Should any information change prior to my entry into the Institution, I will notify the Admissions office. I understand that the application fee(KSH 2000) I submit with this application is non-refundable.

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

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