1. Personal Information

Surname/Last Name

First Name(s)

Email Address

Phone Number

WhatsApp Number

Mailing Address

Preferred method of communication

2. Other Information

Highest level of education completed

Specific objectives or goals for seeking continuing professional development

Work Experience (If Applicable)

Current Employer

Job Title or Position

Years Experience in Relev. Field

Additional Question

How did you hear about the USIU Center for Executive Education?

3. Consent and Privacy

I consent to receive communication and updates about USIU-Africa Executive and Professional Development programs

I agree to the USIU-Africa Privacy policy & Terms of Use