Student Application Form :

Student Information

Student Name: Mr./Mrs./Ms.

Ms Nikalah Starr Douglas

Primary Telephone :
(868) 726-3954

Secondary Telephone :
(868) 341-8623

Email :
nikalahdouglas4@gmail.com

Home Address :
Bellbird Avenue
Malabar Arima
Apt 4-1, Arima East
Trinidad and Tobago

Is an Organization or Company sponsoring you?

No

Particulars of Student

Passport Number :
Tc052260

Expiry Date :
08/08/2021

National ID
20050417007

Expiry Date
04/04/2031

Nationality:
Trinidadian

2235099
 Country of Residence:
Trinidad

Date of Birth
04/17/2005

Place of Birth :
Mt Hope

Marital Status:
Single

Gender :
Female

Academic Qualifications

Education
Institutions Attended Periods Subject Passed and Grades

Malabar Secondary School 2016-2021 English (Grade-3)

Malabar Secondary School 2016-2021 Principal Of Accounts (Grade-3)

Malabar Secondary School 2016-2021 Principal Of Business (Grade-2)

Malabar Secondary School 2016-2021 Office Administration (Grade-2)

Malabar Secondary School 2016-2021 Physical Education (Grade-2)

Employment Records

Employment History
Period Of Employment Organization Job Title Nature of Job

Sep-Jan2023 Vemco Limited Accountant intern Accounting

Emergency Contact Information

Contact Information :
Next of Kin: Relationship: Address: Telephone Contact:

2235099
 Keino Douglas Father Bellbird Avenue 8683418623

Nicole Douglas Mother Bellbird Avenue 8687049462

Supporting Documents

Documents for Submission

Passport Bio Page:
National Identification:
Copies of Academic Certificates:
1 Passport Size Photo
Birth Certificate

Student Signature

Signature
Nikalah Douglas

Date
06/13/2023

Consent
✔ I confirm that the information included in the application form is correct

2235099