Registration Form >> Applicants Registration Stage 1

Pupil Surname *:  

Other Name *:  

State of Origin *:   --Select-- Not in Nigeria Abia Adamawa Akwa Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nasarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara FCT

Parent/Guardian Email *:  

Date of Birth (dd-mm-yy) *:  

Place of Birth *:  

Nationality *:  

Sex *:   -Select- Male Female

Parent/Guardian Details:

Father's Name *:  

Occupation *:  

Address *:  

Telephone (Mobile) *:  

Father's E-Mail:  

Landline:  

Mother's Name *:  

Occupation *:  

Mothers Address *:  

Mobile Telephone *:  

Landline:  

Name and address of the person making application (if neither father nor mother):

Relationship/ Status (eg Legal Guardian):

Guardian Address:

Post Code:  

Telephone:  

Fax: