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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 ____________________
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