Full Names of Student, Surname First
Choose a class
Choose male or female
Email ( A valid Email so as to contact you)
Scan And Upload Your Birth Certificate
Date Of Birth (dd-mm-yyyy)
Permanent Home Address: (Not P.O. Box)
Parent / Guardian’s Telephone No
Name of Your Local Government Area:
State of Origin:
Akwa Ibom State
Cross River State
Federal Capital Territory(Abuja)
Katsina State.Kebbi State
Scan And Upload Your Passport
Any Physical Deformity / Handicap
Any Problem with Sports:
If Yes State Briefly
The name Of Last School Attended
Do you have or Still have any contagious disease?
If Yes,What Is The Name Of The Diseases?
Family Doctor’s name, address and phone no.:
Do you require any of our other services?
Emergency Phone No. and Name to contact:
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