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:
PhoneNo:
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 , 2025.
STUDENT SIGN
PARENT/GUARDIAN SIGN
FIRST EXAMINATION SITTING:
SUBJECT GRADE 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: