Admission form Upload

Enrollment form

Personal Data

Applicant's Details

Passport Photograph

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Surname

Middle Name

Other Name

Course of Study (1st Choice)

Course of Study (2nd Choice)

Programme:

National Diploma

Higher National Diploma

Date of Birth

Gender

Male

Female

Town of Origin

Local Government

State of origin

Nationality

Marital status

Single

Married

Religion

Phone No.

Contact Address

Name of Parents/Guardian or Next of Kin:

Guardian / Parents Data

First Name

Last Name

Relationship with applicant

Phone No.

Address

Extra-Curriculum activities

Are you a member of a secret society? or do you wish to join one?.

Yes

Name of the secret society (IF Applicable).

Education Background

School Information

Name of Schools Attended with Dates (1)

From

Qualification Obtained

Name of Schools Attended with Dates (2)

From

Qualification Obtained

Name of Schools Attended with Dates (3)

From

Qualification Obtained

I hereby declare that all the information given in this form are to the best of my knowledge and belief true and correct. I agree that any false or incomplete information given in this form automatically disqualifies me from from being considered for admission to any course of study at EKITICITY POLYTECHNIC. I also give an undertaking, if admitted to abide by all the rules and regulations of the polytechnic. I understand that failure to comply may result in summary expulsionfrom the polytechnic and thatfees paid are not refundable.

Signature of Applicant

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ATTESTATION - I hereby confirm that this applicant (Mr/Mrs/Miss)

is well known to me. The information supplied in this form is to the best of my knowledge true and correct. The attached photograph is a true resemblance of the applicant.

First Name

Last Name

Address

Phone No.

Personal Data

Name of Parents/Guardian or Next of Kin:

Education Background

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