Online Admission

PERSONAL INFORMATION: COMPLETE FORM IN CAPITALS

PROGRAMME APPLIED FOR *

SCHOOL SESSIONS *

NAME *

TITLE

DATE OF BIRTH

PLACE OF BIRTH

GENDER

AGE

HOMETOWN

REGION

NATIONALITY

RESIDENCE

REGION OF RES

MARITAL STATUS

ADDRESS TO WHICH COMMUNICATION IN CONNECTION WITH THIS APPLICATION SHOULD BE SENT *

TELEPHONE NOS *

E-MAIL ADDRESS *

PERMANENT HOME ADDRESS (IF DIFFERENT FROM ABOVE)

NAME OF PARENT/GUARDIAN/SPONSOR

TELEPHONE NO *

OCCUPATION OF PARENT/GUARDIAN/SPONSOR

ARE YOU PHYSICAL CHALLENGED OR DO YOU SUFFER ANY FORM OF CHALLENGE?YESNO

IF YES PLEASE SPECIFY

ARE YOU CURRENTLY IN EMPLOYMENT?YESNO

IF YES INDICATE TYPE OR NATUR OF EMPLOYMENT

NAME OF EMPLOYER

ADDRESS OF EMPLOYER

WILL YOU REMAIN IN THE EMPLOYMENT WHILE STUDYING?YESNO

IF NO STATE REASON(S)

EDUCATIONPlease list in order of attendance last two academic institutions attended. Also state the dates you attended.

NAME OF INSTITUTION

DATE ATTENDED

NAME OF INSTITUTION

DATE ATTENDED

NAME OF INSTITUTION

DATE ATTENDED

ENTRY QUALIFICATIONSPlease list the qualifications with which you are applying, indicating grades obtained in every examination you took. Attach transcripts and photocopies of all examinations results you list below.

EXAMINATION TITLE

MTH AND YR ATTENDED

INDEX NUMBER

EXAMINATION TITLE

MTH AND YR ATTENDED

INDEX NUMBER

EXAMINATION TITLE

MTH AND YR ATTENDED

INDEX NUMBER

CERTIFICATES *

TRANSCRIPTS *

PASSPORT PHOTO *

PASSPORT, VOTERS ID, GHANA CARD, NHIS CARD *

SUBJECTS TAKEN 1

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 2

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 3

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 4

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 5

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 6

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 7

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 8

ENTRY

ATTEMPTS

GRADES

SUBJECTS TAKEN 9

ENTRY

ATTEMPTS

GRADES

STATE REASON(S) FOR PURSUING INTENDED COURSE

ENDORSEMENTSDeclaration and Signature of Applicant: I declare that the statements on this form are correct. I understand that any offer of admission may be withdrawn if the information provided is fraudulent or if I can not provide documentary evidence.

FULLNAME OF APPLICANT

SIGNATURE *

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ENDORSEMENT BY REFEREEThis form must be endorsed by someone of high repute who must read and sign the following delcaration. I certify that the applicant is personally known to me, and that I have vetted both the photograph attached and claims contained in this application and that to the best of my knowledge, the information can be said to be true.

FULLNAME OF REFEREE

ADDRESS & TELEPHONE

SIGNATURE *

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POSITION/RANK

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APPLICATION FOR ADMISSION