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Personal Information
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Surname
*
First Name
*
Other Name
Email
*
Mother’s Name
*
Mother’s Mobile
*
Admission to Which Class
*
Admission to Which Class
JSS 1
JSS 2
JSS 3
SS 1 ART
SS 1 COMMERCE
SS 1 SCIENCE
SS 2 ART
SS 2 COMMERCE
SS 2 SCIENCE
SS 3 ART
SS 3 COMMERCE
SS 3 SCIENCE
State of Origin
*
Choose state of origin
Abia State
Adamawa State
Akwa Ibom State
Anambra State
Bauchi State
Bayelsa State
Benue State
Borno State
Cross River State
Delta State
Ebonyi State
Edo State
Ekiti State
Enugu State
FCT
Gombe State
Imo State
Jigawa State
Kaduna State
Kano State
Katsina State
Kebbi State
Kogi State
Kwara State
Lagos State
Nasarawa State
Niger State
Ogun State
Ondo State
Osun State
Oyo State
Plateau State
Rivers State
Sokoto State
Taraba State
Yobe State
Zamfara State
Local govt
*
Choose Local Govt
Date of Birth
*
Place of Birth
*
NIN
Tribe
*
Health Problem
(Specify if any)
Address
*
Primary School Information
School Name
School Address
Date
School Name
School Address
Date
School Name
*
School Address
*
Date
*
Secondary School Information
School Name
School Address
Date
School Name
School Address
Date
School Name
*
School Address
*
Date
*
Next of Kin Contact Information
Full Name
*
Relationship
*
Mobile Number
*
Email Address
Address Next of Kin
*
Attachments
Passport Photo
*
Max file size: 5Mb (jpg/png/jpeg)
Primary / Junior Secondary Certificate
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Testimonial
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Birth Certificate /Affidavit
Max file size: 5Mb (jpg/png/jpeg)
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