KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY. Online Application Form 26232024 Academic Year ONLY Please Indicate Vour Envelope Number At The Back Of Your EMS Envelope SUBMIT TWO (2) COPIES OF Tins FORM ‘Ase photocopies ofall related document certificates & rerats [Application i ite without these] ‘Seep a copy of this printout for any future enquiry: Mes adi evidenesofpsmeni(y Pay in Slip 'o this doctment wher postog, = monatiog NB; The name and its arrangement on this application MUST be —=_ EXACTL Result slip, -Y seme as on certificate J ‘Applicant ID: 21471387 ‘Admission Group: ‘Undergraduate International Applicants Application Node: Diploma Tile: Mr. Suruune: RAMISU ‘this yourcorrect FirstName: asuxt, passport size MiddlesOrker Names: ‘ihaaiamasl acgeneee 19 October, 2000 Proceed to submit your. Genae Mate ‘eppiication if your answer is 'YES" Maza! Sts: Single Youcpuid be deniag ‘Home Coury, ee admission if cu upload Home Region: corners nappropriato Passport Se phologreph Phone Noraber: 4234 9060026060 This shat be useain il Ades AMINUHAMISU6720@GMAIL.COM producing your ID Postal Address: JIBIA NIGERIAN CARD upon registration, ; ‘Residential Address: KASTSUNA, JTBIA (Guardians Information Name: Mr. AMINU HANISU Relation to Applicant: Father ceupation: FARMER Phooe Number: 4234 9060926060 Email Address: AMINUHAMISUS720@GMAIL.COM Address SABON GARI. NIGERIAN Programme Choices Choice Programme ‘Stream Fim: PHARMD (DOCTOR OF PHARMACY) 81) Reyutar Second DOCTOR OF OPTOMETRY (oD) (109) Regular ‘Third PHARMD (DOCTOR OF PHARMACY) (981) _Repalr Fou BSC: HUMAN BIOLOGY, MB.CH.B (105) Regular Page 1 of 3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 IF HE HAS ALREADY COME INTO THE UNIVERSITY, HE WILL BE WITHDRAWN, DECLARATION 1, MR. HAMISU AMINU (Exact name and arrangement on my certfiateresult slip) cen that the information provided above is valid and will be held personally responsible for is authenticity and will bear any consequences for any invalid information provided Date of Print Application 1D Envelope Number Signature of Applicant 28 Aug, 2023 21471357 DPHARI3I3 Corraborative Declaration PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE YOU ENDORSE THIS FORM. 1. This Declaration shouldbe signed by 2 person of high integrity and honour who mut also endorse at least ‘one ofthe candidate's passpert-sze photographs on the reverse side and also satisfy himseiMherset that the ‘examination Description and grades indicated on the form by the applicant are correct and gemuin. 2. The application will not be valid if the declaration below isnot signed. 3. Ifthe declaration proves tobe fase, the application shall be rejected: ifthe falsity is detected aller admission the student shall be dismised, Theteby declare that the photograph endorsed by me isthe ue likeness of the applicant MR. HAMISU AMINU whois personally known to me. I have inspected hishher crtiffcates and EXAMINATION DESCRIPTION against the result indicated on the form and ¥ am satisfied that they ae correct and genuine nd the name that appears on them is EXACTLY the same as that by which hese is officiallypersonally known (o me, SIGNATURE... POSITION. CONTACT NUMBER(S) Page 3 of 3Educational Background Institution Programme Pursued ‘GIHERISH COLLEGE OF HEALTH DIPLOMA ‘SCIENCES AND TECHNOLOGY (GOVERNMENT SCIENCE NECO SECONDARY SCHOOL BATAGARAWA Exam Result Ensure this information Exam Type Sitting Exam Year CERTIFICATI. May/June (Schoo) 2022 ‘ON/DIPLOMA / DEGREE Sabject Diploma Exam Type Siting, Exam Yerr - . NECO Maydiune (Schoo!) 2018 (NIGERIA only) Subject BIOLOGY ENGLISH MATHEMATICS Duration September, 2019 - Ap ‘September, 2015 -Jaly, 2018 aceurate [Exam Year] and [Index Number] Index Number PCNIPTIOIUICHCAS Grade 3d Class Index Number 02236711 FF Grade cs cs cs Please Note That EXAMINATION DESCRIPTION (ic Index No., Vear of exam, et.) will be used to Pick RESULTS directly from The West African Examination Council(WAEC) CHECK For ks Validity. Page 2 of 3