Name of Student:
National Identfication No
Next of kin:
UNIVERSITY OF NIGERIA TEACHING HOSPITAL
PMB 01129 Enugu 400001, Nigeria
ADMISSION APPLICATION FORM ADMISSION FORM FOR 2025/2026 ACADEMIC SESSION
STUDENT INFORMATION
Form No: 07859
Sex: Male Female
D.O.B:
Phone No:
Email:
L.G.A:
State Of Origin:
Permanent Home Address:
Current Qualification:
Sponsor Name:
Place of Work:
Phone Number:
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 , 2025.
STUDENT SIGN
PARENT/GUARDIAN SIGN
FIRST EXAMINATION SITTING: SUBJECT
1. English Language
Mathematics
NAME OF COORDINATOR: COMMENT: DATE OF REGISTRATION:SIGNATURE: SSCE .: WAEC: NECO: NABTEB: GCE:
SECOND EXAMINATION
SITTING: SUBJECT
1. English Language
2. Mathematics GRADE
FOR OFFICIAL USE ONLY