YEA REGISTRATION

SKILLS TRAINING MODULE REGISTRATION FORM

Your Personal Details *

Last Name/Surname *

Please enter your last_name

First Name *

Please enter your first name

Other Name(s)

Please enter your other name(s)

Date of Birth *

Please enter date of birth

Please enter valid email

Ghana Card PIN *

GHA-

Please enter ONLY the digits. Ignore the "GHA" !

Please enter Ghana Card Number

What is your Sex? *

Male

Female

Please choose your Sex

Please upload the front part of your Ghana Card *

Please upload the back part of your Ghana Card *

Where do you stay? *

Residential Address *

Please enter your Residential address

GPS Address

Please enter your GPS address

Town *

Please enter town name

Select Region *

Select District *

Contact Details *

Next of Kin *

Please enter Next of Kin's name

Phone Number of Next of Kin *

Please enter valid phone number

Your MOMO Network *

Please enter your Momo network

Your MOMO Number *

Please enter ONLY a registered MOMO number linked to your Ghana Card!

Please enter valid phone number

Do you have any Disability? *

Yes

Please choose whether or not you have a disability

If Yes, what is your disability status? *

Please enter what form of disability

Specify your form of disability*

Educational Level *

Please choose Educational Level

Skill Area *

I do hereby declare that to the best of my knowledge, the Information given in the application form is correct.

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