The Dare to Dream Information Session is coming to Kampot and Kep Provinces! The registration is free so please join us to learn more about the scholarship application process.

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1. ឈ្មោះ / Name (Required.)

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2. ភេទ / Gender

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3. ជនជាតិ​ / Ethnicity

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4. មកពីខេត្ត/ Your province

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6. លេខទូរស័ព្ទ​ / Phone number

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7. តួនាទី/Name of your job or position

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8. ឈ្មោះស្ថាប័ន​ /Name of your Organisation (Required.)

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9. តើអ្នកមានពិការភាពដែរឬទេ?​ Do you have any disability? (Required.)

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10. តើអ្នកមានបំណងចូលរួមកម្មវិធីចែករំលែកពត៌មាននៅថ្ងៃណា? Which day of Information Session are you interested to attend? (Required.)

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11. តើអ្នកដឹងអំពីកម្មវិធីនេះដោយរបៀបណា?​ How do you know about this event? (Required.)

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