CENTURY NIT CONSULT

P.O. Box AT 1360 Achimota Market. Tel: 0302962446 Cell: 0547103680 E-mail: centurynit@gmail.com

ALL IN CAPS
GHANA ASSOCIATION STUDENT PLACEMENT AGENCY (GASPA)

1. NAME ______________________ _____________________ ______________________

First Name Middle Name Surname
2. Date of birth ___________/______________/______________/
Day Month Year

Place of birth ______________________ __________________________

City Country
3. Father’s Name_________________________________________________________
4. Date of birth ___________/______________/______________/
Day Month Year
5. Mother’s Name ________________________________________________________
Date of birth ___________/______________/______________/
Day Month Year
6. Nationality ____________________ 7. Religion _____________________
8. Passport Number _______________Place of Issue ____________Expiring Date ____________
9. Gender and Marital Status: Male Single Married

Female Divorced Widowed

• Name of Spouse_________________________________________________________

• Name of Children________________________________________________________

_________________________________________________________

________________________________________ (attach birth certificates)

10. Mailing Address ℅ __________________________________(applicant’s address only)

P.O. Box _________________________________

Street _________________________________

Country _________________________________

Residential Address:
House № __________________________________

Street & City _______________________________________

 CENTURY NIT CONSULT
P.O. Box AT 1360 Achimota Market. Tel: 0302962446 Cell: 0547103680 E-mail: centurynit@gmail.com

11. Telephone Country Dialing Code: ( )

_________________________ ________________________ _______________________

Mobile Home WhatsApp Number

E-mail __________________________________________________________

Skype ID ________________________________________________________

Facebook___________________________________________________________

12. Family Member Name:

Name Occupation Relation Contact

13. Contact Person in case of an emergency:

Name ………………………………………..Relation………………………….Contact …………………

Name of sponsor: ………………………………Relation:………………………Contact:…………………

14. List all secondary schools attended and dates of attendance. This should include all universities
and / or colleges, if any. The university/ college attendance information is required even if you
are applying as a first-year student.

NB: List the most recent first.

Name of School Course & Grade Location/Address Date of Attendance

obtained From To
dd/mm/yyyy dd/mm/yyyy
 CENTURY NIT CONSULT
P.O. Box AT 1360 Achimota Market. Tel: 0302962446 Cell: 0547103680 E-mail: centurynit@gmail.com

15. Are you enrolled in school this year? If yes, indicate the level you are enrolled in. if no, indicate
what you were doing.
________________________________________________________________________
16. List your hobbies or co-curricular activities of interest to you.
________________________________________________________________________

17. How did you find out about Century Nit Consult?
News Papers Adverts Media Flyers and Posters Families
Friends Presentations Other (specify) ________________________________

CONTRACT

I agree to pay the form fee of GH¢100.00, and upon submission of all required documents,
consideration will be paid in the form of processing fees, which is not at any point refundable. I
also agree to give Century Nit Consult at minimum of 5 weeks for processing, upon which I will
pay the final charged which was agreed between Century Nit Consult and I when the visa is
ready.

NB: It has been the policy of the company to result in arbitration in resolving dispute with our
clients.

18. Please list your course of interest.

Option1:_________________________________________________________________
Option2:_________________________________________________________________
Option3:_________________________________________________________________
Option4:_________________________________________________________________
Option5:_________________________________________________________________
19. Please state the countries you would like to study the courses you have listed above.

ACCEPTANCE FORM

I……………………………………………………………….. hereby confirm that I have read,

understood and agreed to all conditions as stated in the General Information sheet (form).

NAME OF APPLICANT SIGNATURE AND DATE

………………………………………… ………………..………………

Tick where appropriate:

Undergraduate Masters PhD
 CENTURY NIT CONSULT
P.O. Box AT 1360 Achimota Market. Tel: 0302962446 Cell: 0547103680 E-mail: centurynit@gmail.com

OFFICIAL USE ONLY

COURSES NAME OF COST OF REQUIREMENT COUNTRY OF

INSTITUTION TUITION STUDY

UNDERTAKEN

NAME OF STAFF SIGNATURE AND DATE

…………………………………………… ………………………………….……