Report Case - LAMIS

Vocational Rehabilitation Centre Application Form

Application Details

Full Name *

Sex *

Date of Birth *

Primary Telephone Number *

Secondary Telephone Number

Email of Applicant * This will be used to send you an email

National Identification Number * Enter your 14-digit National ID number

Attach National Identification

Click to upload National ID or drag and drop

Location of Applicant

District of Residence *

County of Residence *

Subcounty of Residence *

Parish of Residence *

Village of Residence *

Address of Residence *

Caregiver Details

Does the Applicant have a Caregiver *

Caregiver's Full Name

Email of Caregiver

Caregiver's Secondary Telephone Number

Caregiver's National Identification Number Enter your 14-digit National ID number

Caregiver's Attach National Identification

Click to upload National ID or drag and drop

Applicants' Disability and Functional Profile Details

Disability Category*

Functional difficulties *

Assistive needs/Reasonable accommodation*

Education level *

Prior skills/experience

Preferred course/Trade*

Endorsements & Attachments

Attach LC1 letter

Click to upload LC1 letter

Attach CDO verification note

Click to upload CDO verification note

Attach Passport-sized photo

Click to upload Passport-sized photo

Attach Medical note (if any)

Click to upload Medical note (if any)