TEST PAGE – PIMS

TESTGr12 Upgrad Application (#3) (#25) (#26)

Port Moresby Institute of Matriculation Studies

APPLICATION FOR GRADE 12 UPGRADING

(After completion, click Submit button below to send online)

Date

Study Program Applied For (select and tick)

Pre Matriculation

Adult Matriculation

Grade 12 Upgrading

PIMS Centre

Study Mode

Fulltime

Correspondence

Employment Status

Working

Not - Working

Enrollment Category

New

Re - Enrolling

Transferring - In

How did you find out about PIMS?

Personal Details

First Name

Last Name

Telephone

BMobile

Digicel

Date of Birth

Gender (M/F)

Marital Status

No. of Children

Postal Address

Address Line 1

Address Line 2

City/Town

Province

Zip Code

Country

Residential Address

Employer

Employment Address

Position

Office Location

Educational Details

Please attach copy of certificate (through a separate email)

Last School Attended

Province

Highest Grade Completed

Year

Sponsor Details

Name of Sponsor/Guardian

Employer

Position

Employment Address

Telephone

BMobile

Digicel

Fee Payment Options (Select and tick below)

Full payment upfront on enrolment (one instalment)

Half payment upfront (two instalments)

Special Talents or Skills You Have

Health Condition

Your Future Career Interest

Why Have You Chosen To Enroll At PIMS?

Refund Policy

Refunds within 4 weeks of study commencement will suffer a 50% deduction penalty. No refund after 4 weeks of study commencement.

Declaration

By submitting this application, I the applicant, do solemnly declare that all information that I have provided above is true in every respect, and that I can be held liable for any false information. I pledge to abide by all the school's statutes and regulations while a student at this school.

Signature of Applicant

Date / Time