REGISTRATION
Full Name
*
Date of Birth
*
Phone Number (Preferably WhatsApp)
*
Email
*
Hall of Residence
*
Name of Department
*
Program of Study
*
Level
*
Choose Level
Level 100
Level 200
Level 300
Level 400
Are you involved/ affiliated with other student group or clubs? ( Your affiliations have no bearing on the application process and are only collected for informational purposes only)
*
Yes
No
Are you able to commit to 40hours of mandatory training?
*
Yes
No
Can you commit to facilitating one program monthly as well as attending monthly peer education meetings?
*
Yes
No
How did you hear about this program?
*
Select Medium
VP FM
University Website
Notice Board
From a friend
Orientation
Other
Submit
Clear form