Kirirom Institute of Technology

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ព័ត៌មានផ្ទាល់ខ្លួន/Personal Information

គោត្តនាម-នាម/Full Name *

ភេទ/Sex *

ប្រុស/Male

ស្រី/Female

ថ្ងៃខែឆ្នាំកំណើត/Date of Birth *

YYYY

ទីកន្លែងកំណើត/Place of Birth *

ឈ្មោះវិទ្យាល័យ/High School Name *

ឈ្មោះសាលាដែលអ្នកកំពុងរៀន/Current School Name *

អ៊ីមែល/E-mail *

លេខទូរស័ព្ទទំនាក់ទំនង/ Contact Number *

ឈ្មោះឪពុក/Father's Name

លេខទូរស័ព្ទ/Contact Number

ឈ្មោះម្ដាយ/Mother's Name

លេខទូរស័ព្ទ/Contact Number

កាលបរិច្ឆេទប្រលង/The examination date *

12 May 2017

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