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 Student Information

Study Program: Regular program      Private program 

Name: _____________________________

Father Name: ________________________________________________

Grand Father Name: __________________________________________

Nationality: ____Ethiopian______ Other ______________________

Date of Birth (Eth. Calendar):  Date _______Month _____ YEAR _______

Gender:  Male  Female

Region ___________________ Zone _____________________ 

Woreda ________________ Kebele _______________

School _______________________________________________________

Disability:   None  Handicap  Deaf  Other

Visual Impairment  None    One Eye  Both Eye

Phone Number_______________ Email: _____________________

Study Stream  Natural Science  Social Science

Relative Information

Relation Type 

( Parent  Adoptive Parent  Grand Parent  Guardian  Parents Sibling)

Name _______________________________________________________

Father Name ________________________________________________

Grand Father Name _________________________________________

Gender:  Male  Female

Date of Birth (Eth. Calendar):  Date _______Month _____ YEAR _______

Nationality: ____Ethiopian______(other )_______________________

Residence Region _______________Residence Zone ____________ 

Residence Woreda _______________ 

Sector of Employment ___________________

Phone Number ______________ Email: ______________________