Pacific POLYTECH

Online Application

First Name

Middle Name

Last Name

Local/International:(Required)

Local

International

Birth Registration Number (BRN) : (Required)

Date of Birth dd / mm / yyyy

Gender :(Required)

Male

Female

Marital Status :(Required)

Single

Married

Email :(Required)

Postal Address :

Phone/Mobile No (Required) :

Residential Address :

Parent / Guardian Name :

Parent/Guardian Phone :

TIN (Required - Required for local TSLS scholarship) :

Province

Please indicate whether you have any medical condition(s)
or major illness(es) that will impact on your studies

Ethnicity :(Required)

Highest Qualification

Year

School

Index Number

Marks

Funding Source (Please Pick) (Required)

Private

Will apply for TSLS

Others

Please Select Programme of Study From Dropdown List (Required)

Select 1st Choice Programme:(Required)

Select Campus :(Required)

Select 2nd Choice

Select Campus :

Select 3rd Choice :

Select Campus :

Preferred Year of Study (Optional) :

Course Preferred Month (Optional) :

Documents

Birth Certificate : (Required)

Passport size Photo :(Required)

Most Recent Academic Result (Required) :

Tin Letter/Card : (Required)

By sending this form, you declare that all information supplied here is true and complete in all significant particulars,
and that you agree for Pacific Polytech to seek whatever information it needs to assess your candidature from other sources.