Application Form

Fill the form below and ensure your information is accurate. If you have any questions contact the ICT team.

Personal Information

Title^*

Surname^*

First Name^*

Other Name

Maiden Name

Sex^*

Phone Number^*

Email Address^*

Permanent Home Address^*

Date Of Birth^*

Home Town^*

Nationality^*

State Of Origin^*

L.G.A^*

Marital Status^*

Denomination^*

Next of Kin Information

Next Of Kin Name^*

Next Of Kin Relationship

Next Of Kin Phone number^*

Next Of Kin Address^*

Parents Details

Parent/Guardian's Name^*

Father/Mother/Guardian's Phone number^*

Parent/Guardian's Address^*

Sponsors Details

Sponsor's Name^*

Sponsor's Phone number^*

Sponsor's address^*

Sponsor`s Email Address^*

Jamb Information

JAMB Registration number^*

JAMB Centre^*

JAMB Score^*

Institutions Attended With Dates

S/N

School Name

From

A/O Level Exam Result ( e.g. NECO, WAEC, NABTEB )

Examination Name^*

Examination Date^*

Examination Number^*

Examination Center^*

S/N

Subject

Grade

S/N

Subject

Grade

Examination Details 2 ( e.g NECO, WAEC, NABTEB )

Examination Name

Examination Date

Examination Number

Examination Center

S/N

Subject

Grade

S/N

Subject

Grade

Others Information

Department^*

Programme^*

Other Qualificatione.g. OND, HND

JUPEB Faculty

I, certify that all the information and details given in this form are correct and true and that if at any time in the future it is discovered that I do not possess the result(s) claimed above, the offer of admission will be withdrawn.