MINISTRY OF EDUCATION / GHANA EDUCATION SERVICE

COMPUTERISED SCHOOL SELECTION & PLACEMENT SYSTEM

(CSSPS)
ENROLMENT FORM

Quick Enrolment Code

Application for Entry into Senior High Schools (SHS)/Technical & Vocational Institutes (TVI)
To be submitted to Head of Senior High School or Technical & Vocational Institute placed
(Any erasure renders this form invalid.) - 2020

INDEX NUMBER: 011006007420 TOTAL RAW SCORE (Four Core Subjects): AGGREGATE: 29
180

SHS/TVI PLACED: Tema Manhean Senior High/Tech PROGRAMME: General Science

Enrolment Code: PK6D63

SECTION A: PERSONAL DETAILS OF CANDIDATE SECTION B: PARTICULARS OF PARENTS/GUARDIANS

(To be completed by candidate)
Name of Father:
Name: QURNOR ABRAHAM

Occupation:
Date of Birth: (DD/MM/YY) Place of Birth: Gender: Male

Name of Mother:

JHS Attended: ASHIAMAN NO. 6 JHS Occupation:

Town: Name of Guardian:

District: ASHAIMAN MUNICIPAL Postal Address:

Region: Greater Accra Region Residential Address:

Permanent Address: Residential Telephone:

Signature of Candidate: Other Telephone:

Signature of Parent/Guardian: Date (DD/MM/YYYY):

SECTION C: TO BE COMPLETED BY STUDENT
Indicate your interest:

(a) Athletics [ ] Football [ ] Debating Club [ ] Others [ ]

(b) School Awards:

(c) Position Held:

(d) I, QURNOR ABRAHAM do accept that my admission into this school opens a new chapter in my life. i therefore pledge to abide by
all the rules and regulations of the school

Candidate Witness (Headteacher, Pastor, Snr. Public/Civil Servant, Lawyer)

Name: Name:
QURNOR ABRAHAM

Signature: Signature:

Date (DD/MM/YYYY): Date (DD/MM/YYYY):

SECTION D:
(FOR PLACEMENT ONLY)

Name of Head of SHS/TVI: Signature:

Date/Stamp: Students Identity No. (If Any):