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Zamfara, Nigeria
info@zamfara.gov.ng
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Enrolment Form
1. Biodata
✓
2. Account
✓
3. Education/Health
✓
Identification data/Biodata
Please enter your first name.
Please enter your last name.
Please enter your Email Address.
Select gender
Male
Female
Please select your gender.
Select Marital status
Single
Married
Divorced
Widow
Widower
Please select your marital status.
Please enter your phone number.
Select LGA*
Please select your Local Government area.
Select Ward*
Please select your ward.
Select Community*
Please select your community.
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Account
Please enter your National Identification Number.
Please enter your Bank verification number.
Please enter your Account Number.
Please enter your Bank Name.
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Education & Health Information
Currently Schooling?
Yes
No
Education Level
None
Primary Education
Secondary Education
Diploma
NCE
Graduate
Postgraduate
Employment Status
Employed
Unemployed
Disability Status
Seeing, even if wearing glasses?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Hearing, even if using a hearing aid?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Walking or climbing steps?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Remembering or concentrating?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
With self-care such as bathing or dressing?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Communicating, for example?
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
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Confirm Registration Details
Email:
Password:
Please save these details. You will need them to log in after registration.
