National Telecommunications Regulatory Commission

This form should take you less than 20 minutes to complete.

Full name of parent/guardian *

Address *

Please provide brief directions to your home *

Contact Number *

Preferred Identification(ID) *

ID Number(Passport, Social Security or Drivers Licence) *

Are you employed? *

Name of Employer (if applicable)

Job Title (if applicable)

What is the total monthly income of your household?

Student Information - Enter the name(s) of the students in your household as well as grade or form information. *

When was the last time you had Internet service at home? *

Please select your preferred service provider *

Email *

Username * Please enter a username of your choice which will be used for billing purposes

Password *