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Online Admission Form
Section 1 — Bio Data
First Name
*
Last Name
*
Middle Name
Date of Birth
*
Gender
*
— Select Gender —
Male
Female
Blood Group
— Select —
A+
A-
B+
B-
AB+
AB-
O+
O-
State of Origin
— Select State —
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
FCT Abuja
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
LGA
Religion
— Select —
Christianity
Islam
Traditional
Other
Nationality
Section 2 — Academic Information
Class Applying For
*
— Select Class —
PRY 1
PRY 2
PRY 3
PRY 4
PRY 5
PRY 6
JSS 1
JSS 2
JSS 3
SS 1
SS 2
SS 3
Mode of Entry
— Select —
Fresh Admission
Transfer
Previous School Attended
Year of Last Attendance
Section 3 — Parent / Guardian Information
Father's Name
Mother's Name
Guardian Name
*
Relationship to Student
Phone Number
*
Email Address
Occupation
Home Address
*
Section 4 — Medical Information
Known Allergies
Medical Conditions
Emergency Contact Number
*
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