EmpowerED Fellowship Program - Application Form (1)

1 | EmpowerED Fellowship Program (EFP) Application Form EmpowerED Fellowship Program (EFP) Application Form New City Technical University (NCTU) In partnership with Trego Zambia and the DTLS Program 📅 Application Deadline: 16th November 2025 📧 Submit by Email to : nctuniversity1@gmail.com ______________________________________________________________________________________________ A. PERSONAL INFORMATION Full Name: __________________________________________________ NRC/Passport No.: __________________________________________ Date of Birth: ________________________________________________ Gender: ______________________________________________________ Nationality: ___________________________________________________ Marital Status: ________________________________________________ Contact Number: _____________________________________________ Email Address: ________________________________________________ Residential Address: __________________________________________ Province: ______________________________________________________ District: ________________________________________________________ 2 | EmpowerED Fellowship Program (EFP) Application Form B. ACADEMIC BACKGROUND Level Institution Year Completed Qualification Attained Grade 12 College/University Other (Specify) C. PROGRAMME SELECTION Tick ( ✔ ) one preferred program below. Indicate a second choice if applicable. Bachelor’s Degree Programmes (Choose One): ☐ Bachelor of Science in Computer Science ☐ Bachelor of Information Technology ☐ Bachelor of Business Innovation and Idealogy ☐ Bachelor of Science in Computer Science Education ☐ Bachelor of Management and Finance ☐ Bachelor of Science in CyberSecurity ☐ Bachelor of Science in Data Science & Artificial Intelligence ☐ Bachelor of Data Science and Analytics ☐ Bachelor of Growth Marketing & Digital Branding ☐ Bachelor of AI and Robotics ☐ Bachelor of Science in Digital Health and Biomedical Innovations ☐ Bachelor of Science in Agile Project & Venture Management ☐ Bachelor of Science in Logistics and Supply Chain Management ☐ Bachelor of People Operations & Talent Strategy ☐ Bachelor of Science in Renewable Energy and Sustainable Solutions ☐ Bachelor of Science in Health Informatics & Data Analytics ☐ Bachelor of Science in Environmental Policy and Sustainability ☐ Bachelor of Engineering in Solar and Wind Energy ☐ Bachelor of Science in Genomic and Precision Medicine First Choice: __________________________________________ Second Choice: __________________________________________ 3 | EmpowerED Fellowship Program (EFP) Application Form Diploma Programmes (Choose One): ☐ Diploma in Information Technology ☐ Diploma in Business Management ☐ Diploma in Accounting ☐ Diploma in Cybersecurity ☐ Diploma in Education (ICT, Maths, Graphic Design etc) ☐ Diploma in Project Planning and Management ☐ Diploma in Digital Marketing & Analytics ☐ Diploma in Web Design and Development ☐ Diploma in Computer Hardware and Networking ☐ Diploma in Entrepreneurship ☐ Diploma in Data Analytics ☐ Diploma in Diploma in Health Information Systems ☐ Diploma in Human Resource Management ☐ Diploma in Public Administration ☐ Diploma in Digital Media and Communication ☐ Diploma in Bioenergy Technologies ☐ Diploma in Clinical Data Management ☐ Diploma in Pharmacy Technology ☐ Diploma in Biomedical Equipment Technology ☐ Diploma in Drone Technology and Operations ☐ Diploma in Smart Infrastructure Management D. MODE OF STUDY ☐ Full-Time ☐ Distance/Online Preferred Intake: ☐ January ☐ May ☐ September E. SPONSORSHIP DETAILS Sponsor Name: __________________________________________ Relationship: __________________________________________ Contact No.: __________________________________________ Address: __________________________________________ 4 | EmpowerED Fellowship Program (EFP) Application Form F. DECLARATION I, _______________________________________, hereby declare that the information provided in this form is true and correct to the best of my knowledge. I understand that any false information may lead to disqualification or termination of admission. Applicant’s Signature: ________________________ Date: ________________ FOR OFFICIAL USE ONLY Rec eived By : _____ ____________________ _____ Date Received : ____________________________ Application No. : ___________________________ Admission Decision : _______________________ Remarks : ___ ______________________________ _ Email: admin@nct-uni.org | Website: www.nct-uni.org | Tel: +260 211 237995 5 | EmpowerED Fellowship Program (EFP) Application Form IMPORTANT NOTE TO ALL APPLICANTS Program Fee: The participation fee is a once-off payment towards the Empowered Fellowship Program (EFP) Workshop The amount of K2, 250 covers:  Workshop venue costs  Lunch and dinner during training days  Training materials  Two branded EFP T-shirts  Other logistical expenses in Chongwe All tuition credits will be officially activated during the Chongwe workshop. Minimum Entry Requirements:  Bachelor Applicants: Must have five (5) O’ Levels including English.  Diploma Applicants: Must have four (4) O’ Levels including English.