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| MATRIC NUMBER: | ||||||
| A. Personal Details | ||||||
| Name: | ||||||
| Date of Birth: | ||||||
| Gender: | ||||||
| Email: | ||||||
| Tel No: | ||||||
| State of Origin: | ||||||
| Current Home Address: | ||||||
| Next of Kin's Name: | ||||||
| Next of Kin's Address: | ||||||
| B. Academic Details | ||||||
| Year of Entry: | ||||||
| Year of Graduation: | ||||||
| College: | ||||||
| Department: | ||||||
| Programme: | ||||||
___________________________ BURSARY |
___________________________ STUDENT'S RECORD |
___________________________
REGISTRAR
NB: Please note that you are to come along with original and photocopies of your Ordinary Level Certificates and Receipts of all payments.