COLE SUPERIEURE DE FORMATION DES ACTEURS DE VAUDIOVISUEL, DES METIER DES MEDIAS ET DU MULT-MEDIA AU BERIN ESFAM-BENIN UNIVERSITY ‘Arote Ministerio! c! Ouverture No O10/MESRS/CAB/DC/DPP/DGES/SA du 07 Jarwler 2016 ‘rote Mister do Creiton No S16/MESRS/CAB/DC/S/GM/DPP/DGES/DEPES/SA du 19 Mal 2018, (© (+229) 97621058 67082703, 52348677, 52733524, +234 7030010966, +234 606 727 9904 © wrnestamunivesiy.com @ info@estamuniversiy.com © Agbokou Kouyami,Porto-Novo, Benin Republic FOR OFFICE USE ONLY ‘Application Name: [APPLYING AS A: [APPLYING FOR SEMESTER BEGINNING: 1 Freshmen (First Year Student) [] Fall 20 (1st Semester) CD ruttine Transfer student Spring 20 (2nd Semester) rare time 1 Direct entry CD etearning AFFIX PASSPORT PHOTOGRAPH ECOWAS/INTERNATIONAL PASSPORT NUMBER: Coad ul egal name (as shown on psspor} Sumame FirstName ‘Middle Name Other names that may appear on academic records: Suiname Fit Name ‘Midale Name Phone Numbers): ineuding country code) Applicant e-mail PES Date of Birth State of Origin Pace of Birth Local Govt. rea: Genotype: Blood Group: arial status: L_]singie L]arried LJ other tspectic Country of Citizenship Official Language: Native Language: Gender: Male temate L_Jother (specif Disabilies i any (Speci) Permanent/Home Address Maling Address Mus be physial address: post office boxes not acceptable 1 Different From Permanent Address House Number Steet House Number Street oy State or Province oy State or Province Postalltp Code Country Postalip Code Coury CLASS OF DEGREE asc[_] 6 [] wea[] sc[] ovo 7] Degree in FacultyCOLE SUPERIURE DEFORMATION DES ACTEURS DE ZAUDIOVISUEL, DES TIERS DES MEDIAS ET DU MULTL-MEDIA AU BENIN ESFAM-BENIN UNIVERSITY ‘Arroto Minstoxo! Ouverture No 010/MESRS/CAB/DC/DPP/DGES/SA cu 07 Janvier 2016 {rate Minstrel Croaton No 518/MES9/CAB/5CISIGM/DPP/DGES/DEMS/SA Gu 19 Moh 2018 {© (+225) 97621058 67082703, 52348677, 52733524, +734 7030010966, +734 806 727 9904 © wwvestamuniversity.com @ infow®estamuniversity.com © Achokou Kouyami,Porto:Nove, Benin Republic FOR OFFICE USE ONLY ‘Application Name: ate: File No: EDUCATIONAL BACKGROUND Please provide information regard your educational background below erry i rrr Hy u : ‘0’ Level Result Details (WAEC/NECO/GCE, Etc.) a a NUMBER OF SITTING: i One sitting (two sitting Others (specify) 'NB: photocopies of all diplomas, certificates and course transcripts awarded for these qualifications must be with this application. In addition to diploma and certificates, international, applicants are provide official copies of their entire course transcriptsfeta (ete Relationship Relationship Teh Teh dares ‘any ofthe above boxes are checked; please address and relationship to you of the parents or Guardian with whom you legal reside and to whom official college correspondence should be sent Pena Relationship (e.9. Father, Mother e.t.c) Sponsors Name: Residential Address: country Telephone: Ema Signatures: Date: Erne aud How did you learn about ESFAM-Benin University: Do you have any relative who attended or are currently attending ESFAM-Benin University: CL] Yes. [] No If yes, please provide their names, dates of attendance, and their relationship to you: Have you ever been convicted for acrime [yes []No If yes, please state the nature of the crime ‘Are you ready to adopt French Language as a second Language Ores Ono Do you have your country National ID or Passport. Ores []No Ayes please state the Have you ever attended, been suspended or expelled form ant institution before []¥es []No tes cere greed Cones Please review the statement below and sign: declares that the information on this form is torrect. | understand that any offer ofa place is subject to my acceptance of the university's terms and conditions. | accept that if | do not fully comply with these requirements, ESFAM-Benin University Reserves the right to cancel my application. | agree that ESFAM-Benin University may record and process the information contained in this form in accordance with its Data Protection Policy. Applicant Signature: Date:COLE SUPERIEURE DE FORMATION DES ACTEURS DE VAUDIOVISEL, DES METIERS DES MEDIAS ET DU MULT-MEDIAAU BENIN ESFAM-BENIN UNIVERSITY ‘Arote Minstese!c! Ouverture No O10/MESRS/CAB/DC/DPP/DGES/SA du07 Jarwler 2016 ‘ote Miisteda do Creation No $16/MESRS/CAB/DC/S/GM/DPP/DGES/DEPES/SA du 19 Mal 2018 © (+229) 97621058,67082703, 52348677, 52733524, +234 7030010966, +234 806 727 9904 © woarestamunivesity.com @ info@estamunivesity.com © Agbokou Kouyami, Porto-Nove, Benin Republic FOR OFFICE USE ONLY ‘Application Name: Date: File No: [APPLYING AS A Gti Esfam-Benin University offers admission only to candidates with credit passes in at least 5 subjects including Mathematics and English Language at not more than two sitting in relevant course of study Holders of ather qualifications applying for direct entry and post Graduate study must collect a leter of identification form previous institution] and the institution must be recognized by the Authorities ofthe country (ether in Benin Republic or other countries) Documents submitted for applications willbe kept private of the owner and information contained therein is to scrutiny mainly for admission purpose Nor ith certificate, National Identity or Post Primary School resut e.g SSCE/WAEC (WASSCE) or ‘Applicants must atach four copies ofthe followit equivalent and lve (5) passport photograph, ‘Applicants must give eareful though to his/her choice of program in relation with subject combination and in doubt regarding the choice of course and subject combination should seek advise from the admission offcer or career adviser devise before completing the form, FOR OFFICE USE ONLY INTERNATIONAL ADMISSION OFFICE ‘Admission Status: ‘Accept-Conditional ‘Accept-Unconditional Rejected: Department: Course Status Date: Comment: Name of Admission Officer: Signature: Date: ‘Academics Session Director's Stamp