Doctorate Fellow Nomination Award Form Declaration

It’s the tradition of the institute to extend fellowship Award to Nigerians who have Distinguished themselves in their chosen careers. This awards are given prerogative of the governing council of the institute and is purely on merit.

APPLICATION FORM FEE IS REQUIRED (N15,000)

1. CANDIDATES BIODATA

Upload Your Passport Photographs

Affix 2 recent Passport photographs

Surname

Last Name

Other Name

Date of Birth

Nationality

State of Origin

Religion

Sex

Male Female

Email Address

Office Address

Postal Address

Personal Phone Number 1

Personal Phone Number 2

2. INSTITUTE ATTENDED WITH DATES

Secondary School / College

Year

Tertiary Institution

Year

Membership of Professional Bodies

Year

Others

Year

3. EMPLOYERS

State below the company you are currently working in:

Position

The year you were employed

4. PREVIOUS HONOURS

State below the dates the honours you previously received

Year

5. HOBBIES

6. OTHER INFORMATION

State Briefly Your Personal Life Philosophy

How Much Do You Appreciate This Award?

Have You Been Convicted by Any Court of Law?

YES NO

If yes, Please State The Nature of The Conviction

Will you be willing to be of help to the institute?

YES NO

Please state area(s)

Please be aware that this award is not transferable, if given to you?

Please attach photocopies of your certificates and brief profile of your self

Solemnly declare that all the information given by me in this application for are true and correct, that the institute has a constitutional right from the corresponding authority regarding the authenticity of the attached certificates or qualifications claimed by me, that, I will by all means abide by the constitutional Bye Laws establishing the institute to maintain and keep to the professional ethics, integrity and competence.