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Student Application Form

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Student Application Form

UNDER NO CIRCUMSTANCES IS THE REGISTRATION FEE REFUNDABLE
(THIS FORM IS FOR AGE GROUPS: 18 & ABOVE)

You may either download the application form or complete it online below.

DOWNLOAD: ALANAS Institute Application Form

Applicants are required to:

Pay a registration fee of $5,000.00 (Registration fee is non-refundable)
PAY AT ANY SAGICOR BRANCH
CHEQUING ACCOUNT #: 5503391831

The following documents must accompany this form:

Two (2) certified passport size photographs
Proof of age – (birth certificate)
TRN
NIS
Original and Copies of educational qualification(s) or any other evidence of which grade achieved in school (if any)

NB: A student is not officially enrolled until all the following requirements have been met.

Please ensure that ALL documents and photos submitted are certified by a Justice of the Peace.

SECTION A: PERSONAL DATA

Last Name *
First Name *
Middle Name
Maiden Name
Date of Birth *
Gender *
MaleFemale
TRN # *
Email *
Mobile Number *
Home Number
Mailing Address *
Permanent Address (if different from mailing address)
Do you have any physical disabilities? *
YesNo
If Yes, Please specify

SECTION B: EDUCATIONAL PROGRAMMES

Instructions: Please place a tick in the box beside the most suitable answer/s for you.
AWARD LEVEL *
Skills ProficiencyCertificate Level 1Certificate Level 2Level 3 DiplomaOther
PROGRAMME *
Allied Health - Patient Care Level 2Allied Health - Patient Care Level 3Business Administration (Secretarial Skills) Level 2Business Administrative Assistant Level 3Business Management (Supervision) Level 3Customer Service Level 2Customer Service Level 3Clinical Medical Assistant Certification - AMCAMedical Assistant Certification - AMCAPhlebotomy Technician Certification - AMCAMental Health Technician Certification - AMCAPhysical Therapy Aide Certification - AMCANursing Assistant Certification - AMCABilling and Coding Specialist Certification - AMCAElectronic Health Records Certification - AMCACSEC - Human & Social BiologyCSEC - MathematicsOther
PREFERRED STUDY OPTION *
Examination OnlyAssessment Only
Classes *
Morning ClassesEvening ClassesSaturday ClassesSunday ClassesOnlineOther
If Other, please state
If Other, please state
If Other, please state

SECTION C: EDUCATIONAL INSTITUTIONS

Please list educational institutions attended along with any other programmes/courses you have taken, beginning with the most recent.

Institution Name *

From (mm/yyyy) *

To (mm/yyyy) *

Types of Programmes (Certificate, Diploma, etc.) *

Major Area of Study *

Institution Name

From (mm/yyyy)

To (mm/yyyy)

Types of Programmes (Certificate, Diploma, etc.)

Major Area of Study

Institution Name

From (mm/yyyy)

To mm/dd/yy

Types of Programmes (Certificate, Diploma, etc.)

Major Area of Study

CXC/CSEC/CAPE

Examination Body *

Level *

Subject *

Grade *

Date Awarded *

Examination Body

Level

Subject

Grade

Date Awarded

Examination Body

Level

Subject

Grade

Date Awarded

Examination Body

Level

Subject

Grade

Date Awarded

Examination Body

Level

Subject

Grade

Date Awarded

SECTION D: EMPLOYMENT INFORMATION

Are you currently employed? *
YesNo
Are you self-employed? *
YesNo
Name of Business
Telephone
Position
Period (dd/mm/yyyy)
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

SECTION E: EMERGENCY CONTACT INFORMATION

Please indicate your contact person in the event of an emergency
Title *
Mr.Mrs.Ms.
Last Name *
First Name *
Relationship to Applicant *
Telephone *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Upload Documents

Birth Certificate *
Passport Sized Photograph 1 *
Passport Sized Photograph 2 *
Proof of age *
National Insurance Scheme (NIS) *
Taxpayer Registration Number (TRN) *
Educational Qualification 1 *
Educational Qualification 2
Educational Qualification 3

SECTION F: DECLARATION

I hereby certify that I have read and understood the instructions and information necessary for completing this application and that all statements made are true and complete *
I understand that otherwise my admission or registration to the programme/examination/institution may be revoked. I also understand that my registration fee is NON-REFUNDABLE. PLEASE NOTE THAT ALL OUTSTANDING BALANCES MUST BE SETTLED BEFORE STUDENTS CAN SIT FINAL EXAMINATIONS.Check if you agree
Signature of Applicant *
Date (dd/mm/yyyy) *

Verification

Please enter any two digits *Example: 12
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