Malezi Program Enrolment

Section A: Personal information

Full name * Date of birth ID / passport number * Phone number * Email address (if any) Residential area *

Section B: Current occupation

Are you currently employed? *

Yes No

If yes, state your employer / school / organisation Current role / position

Years of experience caring for children (if any)

None Less than 1 year 1–3 years 4–6 years 7+ years

Section C: Experience with special needs

Have you worked with children with autism or other special needs? *

Yes No

If yes, briefly describe your experience

Do you have any previous training in caregiving or special needs? *

Yes No

If yes, specify

Section D: Motivation

Why do you want to join the Malezi Program? * What skills do you hope to gain from this program? *

Section E: Availability

Are you available for weekend (Saturday) classes for the next cohort? *

Yes No

Preferred mode of communication *

Phone call SMS WhatsApp

Section F: Declaration

I hereby declare that the information provided above is true and accurate to the best of my knowledge. * Applicant's full name (typed signature) * Date *