Company Post Graduate & Undergraduate Form CANDIDATES BIODATA Upload Your Passport Photographs * Attach More Affix 2 recent Passport photographs Surname * Last Name * Other Name Date of Birth * Nationality * State of Origin * Email Address * Sex * Male Female Home Address Mailing Address Personal Phone Number 1 * Personal Phone Number 2 State / Province / Region * Office Address Office Phone Number 1 * Office Phone Number 2 * State / Province / Region * PROGRAMME TO WHICH ADMISSION SOUGHT Degree / Postgraduate Diploma in View Department Faculty FIELD OF INTEREST School and Universities Attended 1. Name of School 1. Town 1. Country Year 2. Name of School 2. Town 2. Country Year 3. Name of School 3. Town 3. Country Year Degrees, Diplomas or Certificates obtained(Class of Degree and Major subject must be stated) Degree Date Subject Class of Degree Degree Date Subject Class of Degree Degree Date Subject Class of Degree 1. Distinctions and Prizes 2. Distinctions and Prizes List of appointments in the past years 1. Post 1. Employer 1. Date 2. Post 2. Employer 2. Date 3. Post 3. Employer 3. Date 4. PREVIOUS HONOURS State below the dates the honours you previously received 1. 2. Publications and the title of thesis, dissertation or essay submitted for any degree (state whether successful and give dates) 1. 2. 3. Are you currently registered for a degree in any university? YES NO If yes, give the name and address of the institution Course registered for Degree in view Degree of First Registration Have you ever applied for admission to Postgraduate Studies at this University? YES NO If yes give the year of application Mode of Study Full Time Part Time If Part-time, where will you be based? Name three persons to whom reference may be made (at least one of these should be one of your lecturers at university level) Name of Reference Position / Rank Address Name of Reference Position / Rank Address Name of Reference Position / Rank Address Ask your referees to complete the enclosed confidential form and return them directly to the Secretary, Postgraduate School, University Sponsorship Give name and address of your sponsor (if any) Sponsorship Name Sponsorship Address Give any other information which you consider relevant to this application. DECLARATION BY APPLICANT I hereby declare that the particulars which I have supplied above are true to the best of my knowledge and belief. NOTE: Please complete the Transcript Label and ask your University to send the label along with your transcript.
