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KWAME NKRUMAH UNIVERSITY OF University Post Office

SCIENCE AND TECHNOLOGY Kumasi-Ghana

+233 3220 60444

+233 3220 61831
Online Application Form
17 June, 2021

Please Indicate Your Envelope Number At The Back Of Your EMS Envelope
SUBMIT TWO (2) COPIES OF THIS FORM
Add photocopies of all related documents, certificates & results [Application is
incomplete without these]
Keep a copy of this printout for any future enquiry.

Personal Information NB: The name and its arrangement on this application MUST be
EXACTLY same as on certificate / Result slip.
Envelope No: BBAIDL/0132
Applicant ID: 20819586
Admission Group: Distance Learning Undergraduate Ghanaian
Application Mode: Top-Up

Title: Mr.

Is this your passport-size Surname: OPPONG

photograph? Other Names: JEFFERY ACQUAH

Proceed to submit your Date of Birth: 13 August, 1995

application if your answer Male
Gender:
is 'YES'.
Marital Status: Single
You could be denied
Home Country: Ghana
admission if you upload
Inappropriate Passport- Home Region: GREATER ACCRA
size photograph.
Present Occupation: ERNEST CHEMIST LIMITED
This shall be used in Place of Work: CIRCLE
producing your ID CARD
upon registration. Phone Number: +233 555366865
Email Address: AQWESIACQUAH95@GMAIL.COM
Postal Address: PLANTATION AVENUE KWABENYA,
ACCRA GE222-7868 ACCRA GHANA
Residential Address: PLANTATION AVENUE STREET
PLANTATION AVENUE KWABENYA,
ACCRA KWABENYA/ GREATER ACCRA

Guardians Information
Name: Mr. JOHN ACQUAH OPPONG
Relation to Applicant: Brother
Occupation: GHANA REVENUE AUTHORITY
Phone Number: +233 275988108
Email Address:
Address: PLANTATION AVENUE KWABENYA,
ACCRA GE222-7868 ACCRA GHANA

Programme Choices

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Choice Programme Stream Option
First BSC. BUSINESS ADMINISTRATION (IDL) - Distance Marketing
TOP UP (964) Learning
(Weekend)
Second BSC. BUSINESS ADMINISTRATION (IDL) - Distance Marketing
TOP UP (964) Learning
(Weekend)
Third BSC. BUSINESS ADMINISTRATION (IDL) - Distance Marketing
TOP UP (964) Learning
(Weekend)
Fourth BSC. BUSINESS ADMINISTRATION (IDL) - Distance Marketing
TOP UP (964) Learning
(Weekend)

Choice for Campus/Centre

First Choice Accra

Second Choice Accra
Third Choice Accra

Educational Background

Institution Programme Pursued Duration

ACCRA POLYTECHNIC HND MARKTING September, 2017 - July, 2020

SWEDRU SNR HIGH SCHOOL GENERAL ART September, 2012 - June, 2015

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Exam Result Ensure this information is accurate [ Exam Year] and [Index Number]

Exam Type Sitting Exam Year Index Number

WASSCE May/June (School) 2015 0030905565
(GHANAIAN)

Subject Grade
Mathematics (Core) E8
Integrated Science E8
Social Studies C5
English Language C6
Economics F9
Geography C5
Government C5
Mathematics (Elective) F9

Exam Type Sitting Exam Year Index Number

WASSCE Nov/Dec (Private) 2016 1031503137
(GHANAIAN)

Subject Grade
Mathematics (Core) C6
Integrated Science C6
Economics D7
Mathematics (Elective) E8

Please Note That EXAMINATION DESCRIPTION(ie. Index No., Year of exam, etc.) will be used to
pick RESULTS directly from The West African Examination Council (WAEC). CHECK For its
Validity.

IMPORTANT

AN APPLICANT WHO MAKES A FALSE STATEMENT OR WITHHOLDS RELEVANT

INFORMATION MAY BE REFUSED ADMISSION. IF HE HAS ALREADY COME INTO THE
UNIVERSITY, HE WILL BE WITHDRAWN.

DECLARATION

I, MR. OPPONG JEFFERY ACQUAH (Exact name and arrangement on my certificate/result

slip) certify that the information provided above is valid and will be held personally responsible for
its authenticity and will bear any consequences for any invalid information provided

Date of Print Application ID Envelope Number Signature of Applicant

17 Jun, 2021 20819586 BBAIDL/0132 ..........................................

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Corroborative Declaration

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE YOU ENDORSE THIS FORM

1. This Declaration should be signed by a person of high integrity and honour who must also endorse at least
one of the candidate's passport-size photographs on the reverse side and also satisfy himself/herself that the
examination Description and grades indicated on the form by the applicant are genuine.

2. The application will not be valid if the declaration below is not signed.

3. If the declaration proves to be false, the application shall be rejected; if the falsity is detected after
admission, the student shall be dismissed.

I hereby declare that the photograph endorsed by me is the true likeness of the applicant MR. OPPONG
JEFFERY ACQUAH who is personally known to me. I have inspected his/her certififcates and
EXAMINATION DESCRIPTION against the result indicated on the form and I am satisfied that they are
genuine and the name that appears on them is EXACTLY the same as that by which he/she is
officially/personally known to me.

SIGNATURE.............................................................................................................................................

DATE........................................................................................................................................................

NAME (BLOCK LETTERS).....................................................................................................................

OCCUPATION.........................................................................................................................................

POSITION.................................................................................................................................................

CONTACT NUMBER (S) .......................................................................................................................

ADDRESS & OFFICIAL STAMP..........................................................................................................

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