FEDERAL UNIVERSITY OF TECHNOLOGY, AKURE

CENTRE FOR CONTINUING EDUCATION

(GUIDANCE AND COUNSELLING UNIT)

STUDENT COUNSELLING REGISTRATION FORM

(STRICTLY CONFIDENTIAL)

SECTION A: PERSONAL DATA

Registration Number: UABS/23/0192

Full name: ENEMALI FAVOUR OJOFUKA
Sex: MALE GSM: 08073039098
Date of Birth: 2003/09/05
Contact Address: 1st Peter Enemali street off Amufi Road Off Benin-Abgor Road Benin city

State Name: EDO Local Govt: ETSAKO CENTRAL

Place of Birth: --------------------------------------------------------------------------------
School: --------------------------------------------------------------------------------
Department: --------------------------------------------------------------------------------

SECTION B: FAMILY DATA

Name Contact Address Phone Number Religion Occupation

Father: -------------------------- ------------------------------------------ --------------------------- ------------------------ -----------------------

Mother: -------------------------- ------------------------------------------ --------------------------- ------------------------ -----------------------

Guardian in Akure: --------------------- ------------------------------------------ --------------------------- ------------------------ ----------------

Next of Kin: ------------------- ------------------------------------------ --------------------------- ------------------------ -----------------------

Relationship With Next of Kin: -----------------------------------------------------------------------------------------------------------

Type of Family (Mono/Poly): -------------------------------------------------------------------------------------------------------------

Number of Children in the Family: --------------------------------------------------------------------------------------------------------

Extra Curriculum Activities: -------------------------------------------------------------------------------------------------------------------

Give information on any special and continuous medical treatment being received and where:

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Any other information about yourself that you think is relevant and useful to the counseling unit:

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Signature Date
UABS/23/0192 UABS-APP-2300208