SERVICE APPLICATION FORM

Full Name of Applicant (Founder/Chancellor/Rector/Director) *

First

Middle

Last

Name of the Institution *

Contact WhatsApp No. *

Contact Email *

Gender of the Applicant

Marital Status of Applicant *

Country *

Region/State *

County/District/Province/LG *

Full Address of the Organization *

Date of Establishment of the Organization *

Service Applying for *

Please tick as appropriate

Organization Present Status *

Registered with Government
Affiliated with other Organization
Accredited by other Organization
Member of other Organization

Highest Certificate of the Applicant *

Please tick as appropriate

Present Number of Staff *

Please tick as appropriate

Services Offered by your Organization *

Purpose of Seeking for our Service *

Other Information as you deem it fit.

How did you get to know us *

Please tick as appropriate

Signature

Write your full name in capital letters

Attestation *

Please tick

I promise to abide by the rules and regulations guiding my Service with Chosen Life Christian University. I promise to display a very high sense of responsibility. I agree that my Certificate of Service can be terminated at any point in time if my organization goes contract to the deeds of contract binding this relationship.