NATIONAL INSTITUTE OF CONSTRUCTION TECHNOLOGY

UROMI, EDO STATE NIGERIA.

REGISTRATION FORM FOR NATIONAL DIPLOMA (ND) PROGRAMME

PLEASE READ CAREFULLY AND FILL OUT ALL NECESSARY INFORMATION CLEARLY IN BLOCK LETTERS. PRINT IN
COLOUR

PASSPORT
PHOTOGRAPH

RED
BACKGROUND

i. REGISTRATION NUMBER: ___________________________________________________

(to be provided by admissions officer)
ii. COURSE OF STUDY:_________________________________________________________
iii. MODE OF STUDY: __________________________________(FULL TIME / EVENING)

PART I
1. SURNAME: ___________________________________________________________________
2. FIRST NAME: ________________________MIDDLE NAME: __________________________
3. GENDER: ______________________________(MALE / FEMALE)
4. DATE OF BIRTH: DAY_______________ MONTH________________ YEAR______________
5. PHONE NUMBER: _____________________________________________________________
6. EMAIL ADDRESS: _____________________________________________________________
7. STATE OF ORIGIN__________________________ LGA ____________________________
8. MARITAL STATUS:___________________________________(SINGLE/MARRIED/
DIVORCED/WIDOWED/WIDOWER)
9. POSTAL ADDRESS :____________________________________________________________
10. NAME AND ADDRESS OF SPONSOR:____________________________________________
__________________________________________________________________________
11. NAME/ADDRESS OF NEXT OF KIN: _____________________________________________
____________________________________________________________________________
12. RELATIONSHIP TO NEXT OF KIN:________________________________________________

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PART

 II

1. JAMB REGISTRATION NUMBER:________________________________________________

2. JAME SCORE: _______________________________________________________________
3. O’LEVEL EXAM INFORMATION:
4. EXAMINATION TYPE: ________________________________________________________
(WAEC/NABTEB/NECO/GCE)
EXAMINATION NUMBER __________________________EXAMINATION YEAR____________

SUBJECTS GRADE
1. ________________________________________________ ____________________
2. ________________________________________________ ____________________
3. ________________________________________________ ____________________
4. ________________________________________________ ____________________
5. ________________________________________________ ____________________
6. ________________________________________________ ____________________
7. ________________________________________________ ____________________
8. ________________________________________________ ____________________

O’LEVEL EXAM INFORMATION SECOND SITTING (IF APPLICABLE):

EXAMINATION NUMBER __________________________EXAMINATION YEAR____________

SUBJECTS GRADE
1. ________________________________________________ ____________________
2. ________________________________________________ ____________________
3. ________________________________________________ ____________________
4. ________________________________________________ ____________________
5. ________________________________________________ ____________________
6. ________________________________________________ ____________________
7. ________________________________________________ ____________________
8. ________________________________________________ ____________________

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PART III

I hereby declare that the information provided in this application, to the best of my
knowledge is accurate

_____________________________________________________________________________________
APPLICANT’S NAME SIGNATURE DATE

ADDITIONAL INFORMATION
This application form MUST BE PRINTED IN COLOUR and filled in duplicate.

Applicants must pay the application fee of N10,000 (ten thousand naira only) to the
Institute through Remita. The application will not be processed if applicant fails to do so.

The completed application form should be emailed along with scanned copy of Remia
payment receipt (and bank teller if paid in the bank) to admissions@nict.edu.ng . On
submission an email will be sent to you carry further details

Visit www.nict.edu.ng for further details or call the following numbers for enquiries

Admissions Officer: 0806 872 7200

Public Relations Officer: 0703 621 6125

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