First Media Academy - Registration form

Course

Intake ID

PERSONAL DETAILS

Salutation*

Race*

Name as in identification*

Nationality*

Identification type*

Gender*

Identification no.*

Date of Birth
(dd/mm/yyyy)

Mailing address*

Postal Code*

Contact no.*

Email*

Spoken Language*

Highest Qualification

Do you have basic computer operating skills?

YesNo

Salary Range

COMPANY / EMPLOYMENT PROFILE AND BILLING INFORMATION

Billing Type:

EMERGENCY CONTACT PERSON

Name

Contact No

OTHERS

Relationship

SURVEY

I have enrolled in this programme for *

I got to know about FMA via

My interests in design are in the following

I intend to pursue a formal qualification in design

UPLOAD DOCUMENTS

NRIC/ FIN / Passport (Front)

NRIC/ FIN / Passport (Back)

PROMOTION CODE

Enter Promotion Code to Waive Registration Fee

APPLICATION DECLARATION

I declare all the information given by me in this application is true and correct. I understand that misrepresentation or omission is sufficient grounds for rejection of my application or withdrawal of any place which may be offered and that this withdrawal may take place at any stage during the course I undertake. I also authorise any investigation of the above information for the purpose of verification. I understand and accept the terms and conditions stipulated by FMA.

I have read and agree with the declaration and privacy policy as detailed in the declaration.

APPLICATION FORM