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YOUTH APPLICATION
MEDIA – VIDEO
Youth Registration Form
Youth Registration Form
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Name
*
First
Last
Gender
Male
Female
Date of birth
Name of School Address
*
City
State
Country
Email
Phone Number (country call code first)
Means of Identification (Please attach a copy)
Driver’s License
National Identity Card
Voter's Card
Work ID
School ID
Travel Passport
Image Upload
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1
Images.
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File Upload
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Browse Files
Upload upto
1
Files.
Max File Size:
Others
What best describes your current education situation? (Please check all that apply and attach certificate/report card)
High School (currently enrolled)
High School certified
High School dropout
University/Polytechnic/College of Education (currently enrolled)
University/Polytechnic/College of Education Graduate
University/Polytechnic/College of Education dropout
Unemployed/Underemployed
Name of School (High School/University/Col of Ed./Polytechnic
From What Year?
To What Year?
Name of Principal/Head of Department
4) Are you currently employed?
Yes
No
If yes, what is the name of your current employer?
What Position?
From What Year?
To What Year?
5) What are the Personal challenges you are facing? Please use the space below to explain all physical, mental, emotional, and spiritual hinderances or obstacles in your life. Whether there are relational, financial, safety or even health issues, please feel safe and free to share, so we know best how we can serve you now and in the future.
*
6) Where do you see yourself in 3-5 years? What are your hopes and aspirations for the future? What are your passions and skills? How do you see yourself putting those to use? Please use the space below to answer.
*
7) How will a 20,000 Naira grant help you? Please use the space below to answer.
*
***If you are UNDER THE AGE OF 18, please ensure the portion of the application below is signed and dated by your parent or legal guardian before submitting your application***
First
Last
Checkboxes
Parent
Guardian
Terms of Agreement
I agree to the terms and conditions stated below:
I, acknowledge that I am the parent or legal guardian of the child, whose information is being voluntarily shared above. I affirm that I am aware of my child’s involvement in and benefit from Abuja 2023 Gospel Community Outreach. I am aware that my child will be benefitting from goods and services relative to the event including, but not limited to, the opening of a bank account, the reception of scholarship/grant funds, the collection of their information for them to be provided continued access to free education resources. I voluntarily release, and forever discharge Marketplace Missions, Inc and Marketplace Dev & Consulting and the Abuja 2023 Leadership Team, its directors, volunteers, and agents from any and all claims, demands or causes of action which are connected with my child’s participation in Abuja 2023 Gospel Community Outreach event. I confirm that I have read the contents of this Consent and Release Statement prior to signing it, and that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.
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