CJVS Initiative

Registration Form

Please fill in all required fields marked with *

Personal Information

Surname *

First Name *

Middle Name

Gender *

Date of Birth *

Nationality *

State of Origin

Local Government Area

Contact Information

Email Address *

Phone Number *

Alternate Phone Number

WhatsApp Number

Residential Address *

City *

State *

Postal Code

Program Selection

Select Program *

Study Mode *

Professional Information

Current Occupation *

Organization / Employer

Years of Work Experience

Professional Body Membership

Payment Information

Payment Option *

Full Payment 5% discount

Installment (50% now, 50% by Week 4)

NGO/Organization Sponsorship

Document Upload

Passport Photograph * JPEG or PNG, max 2MB

Emergency Contact

Emergency Contact Name *

Relationship *

Emergency Phone Number *

Emergency Email

Terms & Conditions

I confirm that all information provided is accurate and complete. *

I consent to the collection and processing of my data for registration and academic purposes. *

I confirm that I have read and agree to the payment terms and conditions. *

Student Registration