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Scratch Program
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Scratch Program
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Name
*
First
Last
PLEASE ENTER YOUR NAME AS YOU WANT IT WRITTEN ON YOUR CREDENTIALS
WhatsApp No.
*
Email
*
Username
*
PLEASE ENTER YOUR PLUSAFRI WALLET IDENTITY
Batch No.
*
PLEASE ENTER YOUR MATRICULATION NO.
Which Batch do you belong to?
*
Batch A
Batch B
Batch C
Batch D
Batch E
Batch F
Batch G
Batch H
Have you received Certificate of Proficiency before?
*
Yes
No
No. on your Certificate
*
Write out the number on the Certificate of Proficiency you have received from ICCA
Name of your Supervisor
*
Write the name of the Officer who supervises you
Which Group do you belong to?
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
Group 9
Group 10
Name of your Group Leader
How many people have you referred to ICCA who have paid and gone through the Diploma Course
None
Between 1 – 2
Between 2 -4
Between 5 – 6
Between 7 – 8
Between 9 – 10
Between 11 – 12
Between 13 – 14
Between 14 – 16
Between 17 – 18
Between 19 – 20
List the names of your Referrals who are already registered with ICCA
Did you attempt your Batch Examination
*
Yes
No
What do you think is responsible for your inability to earn International Diploma
Signature
*
Write your full name in CAPITAL letters
Attestation
*
Tick
I promise to abide by the rules and regulations guiding my fellowship and collaboration with ICCA. I promise to display a very high sense of responsibility. I agree that my CERTIFICATE can be withdrawn at any point in time if I am found wanting in speech and character.
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