REGISTRATION FORM

Academic year 20…………../ 20…………….. PASS PORT

PHOTO
Proposed Option :

Class :

Status : Distance Learning

CIVIL STATUS
Name :
Surname(s) :
Born (e) on : at :
Nationality :
Adress :
Tel. I : Tel II:
e- mail :
CONTACT PERSON
Names :
Adress :
P.O Box : Town :
Country :
Tel I : Tel II:
E-mail :
Commitment on registration requirements

The tuition fees is payable in installments. The access on term exams will be denied if the installment is not
totally paid. The paid amount is not refundable. A receipt is given by the financial manager when the student
presents the slip.

Date and Signature of Recipient

(preceded by the mention approved)
EDUCATIONAL BACKGROUND

The highest degree :

Location & Dates Certificate

School Address attended Specialisation Awarded

TEACHING LANGUAGES
Langues Fluency Average Basic knowledge
English
French

DOCUMENT TO BE PRESENTED ?

Copy of last degree :………………………………………………………………………………

Academic transcripts :……………………………………………………………………..

Copy of National ID :……………………………………………………………………...

Two Passport Photo :…………………………………………………………….

The dully registration form :……………………………………………………………

The bank slip of registration fees

BANK ADDRESS

Pay directly to the partnership Bank address

Bank of Kigali
Account name: Institut Supérieur de Technologies
00270-06928759-03/RwF : Bank of Kigali ; 00270-07715447-15/USD Bank of Kigali

RESERVED TO THE ADMISSION DEPARTMENT

Date of application :
Position of admission official :
Refused
Accepted : A B C

Names and et signature of the Responsible

N.B
1. To fill all of the information is compulsory and send on admission@istburkina.org,
2. The registration fees are about 120USD for Master , 120USD for Bac IV, 50USD for Bac I