Academy Registration - Pinnacle Brainiac Academy

Section A: Personal Information

Surname *

First Name *

Other Name(s)

Gender *

Date of Birth *

Marital Status *

Nationality *

State of Origin *

Local Government Area (LGA) *

Section B: Contact Information

Residential Address *

Phone Number (WhatsApp preferred) *

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Section C: Identification & Document Uploads

Recent Passport Photograph (JPG/PNG, max 5MB)

Valid Means of Identification *

ID Number *

Section D: Educational / Professional Background

Highest Educational Qualification *

Field of Study / Profession (if any)

Current Occupation / Status *

Section E: Business & Entrepreneurship Profile

Do you currently own a business?

Have you received prior business or entrepreneurship training?

Section F: Area of Focus

Preferred Area(s) of Focus (Tick all that apply) *

Business Startup & Idea Development Entrepreneurship & Innovation Small & Medium Scale Business Management Real Estate & Property Investment Sales, Marketing & Branding Digital Business & Online Entrepreneurship Financial Literacy & Wealth Creation Leadership & Corporate Strategy Agribusiness

Section G: Area to be Empowered (If Needed)

Do you desire empowerment support after training?

Section H: Program Commitment & Performance Requirement

Important Notice to All Learners:

You must score a minimum of 70% in all tasks, assignments, assessments, and projects to qualify for CERTIFICATION.
You must score a minimum of 90% overall to qualify for EMPOWERMENT consideration.
Empowerment is merit-based and subject to availability and management approval.
Attendance, discipline, participation, and project execution are compulsory.

I agree to abide by the academy's rules, assessment standards, and performance requirements *

Section I: Declaration

I hereby declare that all information provided in this form is true and accurate to the best of my knowledge. I understand that any false information may lead to disqualification from the program.

I declare that the information above is true and accurate *