Registration Form

Personal Details

First Name

Middle Name

Last Name

Gender

Date of Birth

Phone No 1

Phone No 2

Residential Address

State

Country

Passport Photograph

Affix Passport Photograph

Parent/Guardian Details

Full Name

Phone No (Home)

Residential Address

Phone No (Office)

Office Address

Educational Details

Secondary School Name

Graduate Year

(WAEC/NECO/NABTEB) - First Sitting

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Grade

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Grade

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Grade

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Grade

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Grade

(WAEC/NECO/NABTEB) - Second Sitting

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Grade

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Grade

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Grade

Program Details

A'Level Subject Combination

First Choice University

Second Choice University

When Will You Resume For Lectures?

Program Type

IJMB Program

JUPEB Program

Attestation

Please read and agree to the following terms:

I agree that if caught in any form of misconduct and misbehaviour, I should be penalized.

I agree that fees are non-refundable.

All fees must be paid before the final exam, failure to do so all fees paid should be considered mill.

If caught in any form of vandalization of the school's property I should be held responsible for replacement.

I must be modest in my appearance.

I must be punctual and regular in my classes, failure to should attract penalty.

I agree that these information about me are accurate

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Personal Details

Parent/Guardian Details

Educational Details

(WAEC/NECO/NABTEB) - First Sitting

(WAEC/NECO/NABTEB) - Second Sitting

Program Details

Attestation

Please read and agree to the following terms:

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