Page 1 of 1
10X PROGRAM REGISTRATION FORM
10x program aimed at elevating young women for dignified work in the digital economy implemented by Purple skills klinic foundation in partnership w WITU, outbox and Mastercard foundation.
Personal Information
Full Name
*
Date of Birth
*
Nationality
*
Email
*
Contact
*
Home Address
*
Emergency Contact Name
*
Emergency Phone Contact
*
Do you have any disability or medical condition we should be aware of
*
Do you have any disability or medical condition we should be aware of
Yes
No
If yes specify
*
Education Background
Highest Level of Education
*
Highest Level of Education
PLE
UCE
UACE
Certificate
Degree
Masters
Year of Completion
*
Program Interest
What is your Preferred course
*
What is your Preferred course
Graphic Designing
Data Analysis
Videography & Photography
Digital Marketing
Deejaying
Which device do you own
*
Which device do you own
Smart phone
Laptop
Both
None
Others
*
Do you have basic computer skills
*
Do you have basic computer skills
Yes
No
What's your employment status
*
What's your employment status
Employed
Unemployed
Gig Work
If employed What is the nature of your business?
*
Have you had any ICT-related Training
*
Have you had any ICT-related Training
Yes
No
If yes specify
*
How did you hear about the program?
*
How did you hear about the program?
Social Media
School/Institution
Friend
Others
Do you agree to abide by the rules and regulations of the program
*
Do you agree to abide by the rules and regulations of the program
Yes
No
Signature
*
Submit
