LAGOS UNIVERSITY TEACHING HOSPITAL
P.M.B. 12003, IDI-ARABA, LAGOS STATE
ADMISSION APPLICATION FORM
ADMISSION FORM FOR 2025/2026 ACADEMIC SESSION
STUDENT INFORMATION
Name of Student:
National Idetification No:
Next of kin:
Sex: Male Female
D.O.B:
Phone No:
Email:
L.G.A:
State Of Origin:
Permanent HomeAddress:
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:
SIGNATURE: