Mumsa High School Mityana S.1 Online Registration Form

Section A: Personal Information

Student's Name: Sex: Male Female Date of Birth: Home District: Religion: Nationality:

Section B: Student's Performance

Previous School Attended: Address: Where did you sit PLE?:

Examination Results:

Index Number: In case you have a chronic disease, state it: Father's Name: Mother's Name: Contact Address: Email: Signature: