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Student Registration Form
Surname
*
Othername
*
Phone Number
*
Email
*
Matric. No.:
*
Exam. No.:
*
Programme:
*
--- Select Programme ---
Higher National Diploma (HND)
National Diploma (ND)
Programme mode:
*
--- Select Programme mode ---
ND Full Time
HND Full Time
ND Part Time
HND Part Time
ND Evening Classes
HND Evening Classes
ND Weekend Classes
HND Weekend Classes
Level:
*
--- Select Programme Level ---
100
200
300
400
Birth date
*
Day
1
2
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5
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9
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31
Month
Jan
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Select Year of Birth
1950
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1996
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1998
1999
2000
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2004
2005
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2007
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2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Gender
Male
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Religion
*
--- Select Religion ---
Christianity
Islam
Traditional
State
*
--- Select State ---
FCT-Abuja
Zamfara
Yobe
Taraba
Sokoto
Rivers
Plateau
Oyo
Osun
Ondo
Ogun
Niger
Nassarawa
Lagos
Kwara
Kogi
Kebbi
Katsina
Kano
Kaduna
Jigawa
Imo
Gombe
Enugu
Ekiti
Edo
Ebonyi
Delta
Cross River
Borno
Benue
Bayelsa
Bauchi
Akwa-Ibom
Anambra
Adamawa
Abia
Residential Address
*
Next of kin
*
Next of kin phone
*
Next of kin Address
*
Parent/Guardian Name
*
Parent/Guardian phone
*
Parent/Guardian Address
*
Secondary School Attended
*
Year
*
From:
*
Select Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
To:
*
Select Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Primary School Attended
*
Year
*
From:
*
Select Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
To:
*
Select Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024