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Lofa County Deaf Academy Admission Form

This document is a registration and admission form for the Lofa County Academy for the Deaf in Voinjama City, Liberia. It collects personal information, family affiliation, and health details of the applicant, including reasons for deafness and current living situation. The form also includes sections for emergency contact information and parental signatures.

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askamara35
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11 views2 pages

Lofa County Deaf Academy Admission Form

This document is a registration and admission form for the Lofa County Academy for the Deaf in Voinjama City, Liberia. It collects personal information, family affiliation, and health details of the applicant, including reasons for deafness and current living situation. The form also includes sections for emergency contact information and parental signatures.

Uploaded by

askamara35
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

PHOTO LOFA COUNTY ACADEMY FOR THE DEAF

VOINJAMA CITY, LOFA COUNTY


REPUBILIC OF LIBERIA
REGISTRATION AND ADMISSION FORM

1. Personal Information
Name: ____Fayiah Sia____________________________________________
Last First Middies
Data Of Birth: July ________ 23 __________ 2000____________________________
Month Date Year Gender
Place Of Birth__foya BOMA
solombo foya ___ foya Village
Town City District Nationality: Liberian
lofa___________________________________________________
County Of Organ Religious Affiliation

[Link] Affiliation
Father Name: fayiah tumbay-
_____________________________________________________
Occupation_farmay_____________________________Cell_____________________________________
Mother Name: yawah fayiah_______________________________________________________
Occupation _farmay____________________________ Cell_______________________ Do You
Live With You Parent ( S ) If Yes__(yes)_ No, Why?

_____________________________________________________________________________________
Why You Became Deaf she was born deaf with it_____________________________________________
Do You Have Any Problem do Your Health? If Yes, Explain:
___cold______________________________
_____________________________________________________________________________________
With Whom Do You Live Presently? __I live with my mother____________________________________
Where: __Solombo____________________________ Contact:
0778806295_______________________ How Do You Meet Your Presently?
_________________________________________________________
Who Are You Currently Living With? ___________________________________________________
Location:________________________________________
Cell :______________________________ Do You Have Any Relative In County? If Yes, Name of
County: _________________________ Relative
Name: Mr. /Madam: ___________________________________________________________________
Occupation: _______________________ Address
_____________________Cell:________________
Portent’s Emergent Contact
Photo Name: ____________________________________ Admission Only
Call:_____________________________________
Sign:_____________________________________
Date_____________________________________

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