KENULE BEESON SARO-WIWA

POLYTECHNIC
P.M.B. 20
BORI
APPLICATION FOR FULL-TIME ND PROGRAMME FOR 2020/2021 SESSION
APPLICATION NO: 2020/244163 JAMB REGISTRATION NO: 21259695GF
A. AREA OF CHOICE
First Choice School ENGINEERING

First Choice
Department. MECHANICAL ENGINEERING

Second Choice School ENGINEERING

Second Choice
Department. MECHANICAL ENGINEERING

Programme of Study FULL-TIME-ND

B. PERSONAL DETAILS
Name of Applicant
Surname: AUGUSTINE

First Name: CHINEDU

Other Names: JOSHUA

Previous Names:

Date of Birth: 2004-04-26 Marital Status: Single

Nationality: Nigerian State of Origin: Rivers

L.G.A.: Omumma District:

Home Town: email:

Contact Address: LAGOS STATE

Name and Address of

Parent/Guardian: MBAERI AUGUSTINE, LAGOS STATE | AUGUSTINE NKECHI, LAGOS STATE

Name and Address of

next-of-Kin: ,

Phone No: +234 814 923 8504

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C. ACADEMIC RECORD
Post Primary Institutions Attended with dates
Name and Address of Institution From To

Quali cations
WEST AFRICAN SCHOOL CERTIFICATE/ GENERAL SENIOR SECONDARY SCHOOL CERTIFICATE (O'L)
CERTIFICATE OF EDUCATION O/L
Subjects Grades Year
Subjects Grades Year
English Language B3 2011

MARKETING B3 2011
Date:
Center: Biology C4 2011
Exam No.:
Chemistry B3 2011

Physics B3 2011

Mathematics B3 2011

Further Mathematics C6 2011

Date: 2011
Center: NAVINA COLLEGE ETEGBIN LAGOS STATE
Exam No.: 4253750011

NATIONAL EXAMINATION (O'L) (NECO) NATIONAL DIPLOMA/OTHERS

Subjects Grades Year Subjects Grades Year

Date: Date:
Center: Center:
Exam No.: Exam No.:

WORKING EXPERIENCE
Name and Address of Employer Nature of Job From To

E. DECLARATION AUGUSTINE, CHINEDU JOSHUA Hereby declare that all the information given in this form is accurate. I
understand that any false information will automatically disqualify me from being considered for admission to, or continuing
with any course of study in the Polytechnic.

Signature:___________________________________________________ Date:___________________________________________________

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