JOINT ADMISSIONS AND MATRICULATION BOARD

Unified Tertiary Matriculation Examination (UTME) Application Form Sheet Template Recent Passport Photo Not older than (3 months)

First Name Date of Birth:

Middle Name

Surname (Family Name)

Sex (Male or Female): Day/Month/Year Disabilities (Blind/Deaf/Physical Handicap):

Town/State State /Country

Marital Status (Single/Married/Divorce): Postal Address:

Address

Note: Address, Town and State for Address in Nigeria while Address, State and Country for Address Outside Nigeria

Email: Nationality (Nigerian/Non Nigerian): State of Origin: State of Exam Town:

GSM No:

Local Govt. Area: Exam Town:

First Most Preferred Institution (Degree/ND/NCE): Course: First More Preferred Institution (Degree/ND/NCE): Course: First Preferred Institution (Degree/ND/NCE): Course: Second Most Preferred Institution (Degree/ND/NCE): Course: Second More Preferred Institution (Degree/ND/NCE): Course: Second Preferred Institution (Degree/ND/NCE) : Course: OLevel Type (e.g. WAEC, NECO, GCE London etc) UTME Subjects Use of English OLevel Subjects 1. 2. 3. 4. 5. 6. 7. 8. Number of Sittings (Maximum of 2) Grades

1. 2. 3. 4.

NB: Your Biometrics (Thumb Prints) shall be captured at the point of creating Account.