LAGOS UNIVERSITY TEACHING HOSPITAL
P.M.B. 12003, IDI-ARABA, LAGOS STATE
ADMISSION APPLICATION FORM
ADMISSION FORM FOR 2026/2027 ACADEMIC SESSION
STUDENT INFORMATION
Nameof Student:
NationalIdetificationNo:
Next of kin:
Sex: Male Female
D.O.B:
Phone No:
Email:
L.G.A:
State Of Origin:
PermanentHomeAddress:
Current Qualification:
Sponsor Name:
Place of Work:
PhoneNumber:
Sponsor’s Details:
ATTESTATION
I, hereby declare that i am not a member of any secrete cult and that the information I have provided above is true and correct this day of , 2026.
STUDENT SIGN
PARENT/GUARDIAN SIGN
FIRST EXAMINATION SITTING:
SSCE .: WAEC: NECO: NABTEB: GCE:
1. English Language
Mathematics
SECOND EXAMINATION SITTING:
SUBJECT
1. English Language
2. Mathematics GRADE
FOR OFFICIAL USE ONLY
NAME OF COORDINATOR:
COMMENT:
DATE OF REGISTRATION:
SIGNATURE: