STANDARD APPLICATION FORM FOR ENTRY INTO A TERTIARY INSTITUTION IN NASARAWA STATE

Institution to which Application is being made ……………………………………………..

Academic Session 20……………/20…………….

SECTION A. PERSONAL DETAILS (USE BLOCK CAPITALS)

1.Last Name (SURNAME)………………………………………………………….………………....

Other Names…………………………………………………… Gender……………..….

2. State/Country of Origin……………………………..…… (b) Date of birth……………………..

3. L.G.A (For Nigerians only)..………… Constituency…………… District……………………..

Home Town………………

4. (a) Marital Status (Married/Single) …………………………………………….……………….

(b) Religion…………………………………………………………….………………...

5. Course Applied For…………………………………………....

6. School of……………………………………………………………………………………………..

SECTION B. ACADEMIC RECORDS

Post Primary/Secondary and other Institutions attended

INSTITUTION	LOCATION	PERIOD
		FROM	TO

SECTION D. ACADEMIC QUALIFICATIONS

Itemise your current academic qualifications:

1. …………………………………………………………………………………………..

2. …………………………………………………………………………………………..

3. …………………………………………………………………………………………..

4. …………………………………………………………………………………………..

Applicants are advised to enclose photocopies of all academic qualifications, please.

I,………………………………………………………………………..hereby declare that:

i. All the information given in this form, are, to the best of my knowledge and belief correct.

ii. Any false or incomplete information given in the form will automatically disqualify me from continuing with any course of study in the College.

Student’s Signature……………………………………………Date……………………….

SECTION C. (FOR OFFICE USE ONLY)

v Form received by: ……………………………….

v Date: ………………………………………….

v Signature …………………………………………….

v Details of academic transcripts ……………………

v Acknowledgement …………………………………..