CSBM Student Application Form

Program Category

Title of the Program

1. General Information

1.1 NIC / Passport

1.4 Date of Birth (D / M / Y)

1.2 Name with Initials

1.3 Full Name (Rev / Dr / Mr / Mrs / Ms.)

1.5 Gender

1.6 Nationality

1.7 Marital Status

2. Contact Information

2.1 Permanent Address

2.2 Residential No.

2.3 Mobile No.

2.4 Mailing Address

2.5 Email Address

2.7 Office Email (if Applicable)

2.6 Office Address (if Applicable)

2.8 Office No.

3. Parent's / Guardian's Contact Details (for applicants under 18 years of age)

3.1 Family Name

3.2 Given Names

3.3 Relationship to Applicant

3.4 Residential Address

3.5 Residential No.

3.6 Mobile No.

3.7 Office No. (if Applicable)

3.8 Email Address

4. Working Experience (if Applicable)

Company

Address

Designation

Period From

Period To

Remove

5. Educational Qualifications

5.1 G.C.E. (O/L)

Year

Index No.

School

Subject

Grade

Medium

Remove

5.2 G.C.E. (A/L)

Year

Index No.

School

Subject

Grade

Medium

Z-Score

Remove

5.3 Higher Education

Institution

Program

From

To

Remove

Payment Plan

Select your preferred payment option. The exact payment plan will be confirmed by CSBM during approval.

Option A - One time payment ( 7.5% Discount ) Option B - Semester Payment ( 5% Discount ) Option C - Installment payment ( 0% Interest ) Request special payment plan

Existing Documents

These documents are already uploaded for this student. File inputs cannot be filled automatically by the browser, but existing files will remain available in the student document record.

6. Other Information

How did you first learn about CSBM? You may tick more than one.

Exhibition / Seminar Newspaper / Magazine Recommended by a friend/relative Friend/relative is a CSBM student Education agent Internet Other

Declaration

I declare the information I have supplied on this form is, to the best of my understanding and belief, complete and correct. I understand that giving false or incomplete information may lead to my application being refused or my enrolment cancelled.

Applicant’s Signature (e-sign)

Sign here

Optional: Upload a signature image (PNG/JPG). If uploaded, it will be used instead of the drawn signature.

Parent’s/Guardian’s Signature (if applicable) (e-sign)

Sign here

Optional: Upload a signature image (PNG/JPG). If uploaded, it will be used instead of the drawn signature.

Applicant Date

CSBM Campus

1. General Information

2. Contact Information

3. Parent's / Guardian's Contact Details (for applicants under 18 years of age)

4. Working Experience (if Applicable)

5. Educational Qualifications

5.1 G.C.E. (O/L)

5.2 G.C.E. (A/L)

5.3 Higher Education

Payment Plan

Existing Documents

6. Other Information

Declaration