Application Form
General Information
Title*
Surname*
First Name*
Other Name
Sex*
Permanent Home Address*
Phone Number*
Personal Information
Date Of Birth
DD/MM/YYYY
*
Home Town*
Nationality*
State Of Origin*
L.G.A*
Marital Status*
Maiden Name
Denomination
Next of Kin Details
Next Of Kin Name*
Next Of Kin Relationship
Next Of Kin Address*
Next Of Kin P.O.Box
Next Of Kin Phone number*
Parent/Guardian's Details
Parent/Guardian's Name*
Parent/Guardian's Address*
Father/Mother/Guardian's Phone number*
Sponsor Details
Sponsor's Name*
Sponsor's Email address
Sponsor's Occupation
Sponsor's address*
Sponsor's Phone number*
Email Address
Email Address*
Institutions Attended With Dates
School Name From (YYYY) To (YYYY)
*1
2
3
4
5

A/O Level Exam Result ( e.g. NECO, WAEC, NABTEB )
Examination Name*
Examination Date
DD/MM/YYYY
*
Examination Number*
Examination Center*
Exam Result, Specify your result in the form A1, B3, C6, E8
Subject Grade Subject Grade
1 2
3 4
5 6
7 8
9 10

Examination Details 2 ( e.g NECO, WAEC, NABTEB )
Examination Name
Examination Date
DD/MM/YYYY

Examination Number
Examination Center
Exam Result, Specify your result in the form A1, B3, C6, E8
Subject Grade Subject Grade
1 2
3 4
5 6
7 8
9 10

Other Examinations (e.g. JAMB)
JAMB Registration number*
JAMB Centre*
JAMB Score*
Current Level/Level Applied For * Select as applicable
Programme*
Other Qualification
e.g. OND, HND

JUPEB
Faculty*
Subject Combination*
Department for studies. Learn more about our faculties and departments.
Department*
Referer
How did you hear about madonna
Declaration*
I, certify that all the information and details given in this form are correct and true and that if at any time in the future it is discovered that I do not possess the result(s) claimed above, the offer of admission will be withdrawn.
Agree     Reject