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ALLOVER CENTRAL POLYTECHNIC

By April Davis,2014-08-13 09:11
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ALLOVER CENTRAL POLYTECHNIC ...

    ALLOVER CENTRAL POLYTECHNIC

     SANGO-OTA, OGUN STATE

     ATTEMPTP.O. BOX 13453 IKEJA, LAGOS SUCCESS

     AFFIX a Recent APPLICATION FORM FOR ADMISSION TO Passport Size DIPLOMA/ND/HND PROGRAMMES FOR THE ACADEMIC YEAR Photograph BEGINNING 20……/20…….

APPLICANT’S NAME:

     SURNAME (In Block Letters) OTHER NAMES

FACULTY:

     (As advertised)

DEPARTMENT:

PROGRAMME:

     (i.e. PRE-ND, ND, HND, Post HND, CERTIFICATE/DIPLOMA)

     STCOURSE (1 Choice)

     (e.g. ND Accountancy)

     ndCOURSE (2 Choice)

     (e.g. ND Business Administration & Management)

JAMB REG. NO:

FOR OFFICIAL USE ONLY

Passport Photograph (4 Copies)

    Receipt

    Photocopies of Credentials

    Birth Certificate/Sworn Declaration of Age

    JAMB Result Slip (If available)

    One Self Addressed Stamped Official Envelope

    FORM ACP. 01 N.B: The Form is to be completed in DUPLICATE and returned with the documents indicated above.

    ALLOVER CENTRAL POLYTECHNIC

    NOTE: Please type or print (in block letters)

     On the dotted lines

1.

    (a) Name:

    Surname (In Block Letters) Other Names

     (Attach proof if names have changed)

    (b) Postal Address:

    (c) E-mail Address:

    Tel No.

    (d) Date of Birth: 19 (e) Sex:

    (f) Nationality: (g) State of Origin:

     (h) Local Government: (i) Marital Status:

    (j) Maiden Name:

    (for married women only)

    (k) No. of Children: (l) Religion:

2.

    (a) Name and Address of Parent/Guardian or Next of Kin

    Name:

     Surname (in block letters) Other Names

    Address:

     Tel No:

    E-mail Address:

    Relationship to Applicant:

    (b) Extra-Curriculum Activities, e.g. (Sports/Hobbies)

    3. Mark X in the relevant box

     Blind Deaf Dumb Deaf & Dumb Others: Specify

     e.g. Asthmatic

    4.

    (a) Institutions Attended with dates:

     Period

    Name of Institution Qualification

    From To Obtained

(b) Examinations Passed or Entered for (Photocopies of Certificates and Statement of Result

    must be attached)

     WASC/GCE SPECIFY

    SUBJECT OTHERS

     ST ND1SITTING 2 SITTING

    Date of Exam………….. Date of Exam…………..

    Exam No………………. Exam No……………….

    ………………………….. …………………………..

    Grades Grades

    1. English Language 2. Mathematics

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    5. (If any)

    Employer Post Dates Salary (P.A.)

(HND applicants must attach evidence of at least one year post-ND relevant Employment)

6.

    I, hereby declare that all the

    information given in this form is 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

    being considered for admission to any course of study at the ALLOVER CENTRAL

    POLYTECHNIC. I also give an undertaking, if admitted to abide by all the rules and regulations of

    the Polytechnic. I understand that failure to do this may result in summary expulsion from the

    Polytechnic and that fees are normally not refundable.

     Signature of Applicant Date

7.

    I hereby confirm that this applicant Mr/Mrs/Miss

     is known to me. The information supplied in his/her form is to the best of

    my knowledge true and correct. The attached photograph endorsed by me is a true resemblance

    of the applicant.

    Full Name:

    Address:

    Position Held:

    Signature: Date:

8. Change of Course

     STNDSTND1 CHOICE 2 CHOICE 1 CHOICE 2 CHOICE

    Subject Grade Subject Grade Subject Grade Subject Grade

    1.

    2.

    3.

    4.

    5.

    6.

    7.

    8.

    9.

    10.

    Score: Score: Score: Score:

     Score by: Date Score by Date

     Name Name

    Score by: Date Score by Date

     Name Name

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