THE FEDERAL POLYTECHNIC

P.M.B. 1012 KAURA NAMODA, ZAMFARA STATE

2023/2024 APPLICATION FORM FOR ADMISSION
TWO COPIES TO BE PRINTED

Form No.: 4522781722 Serial No.: 404565

THIS FORM IS FOR ALL PROGRAMMES OFFERED IN THE POLYTECHNIC:- REGULAR, FULLTIME, PART TIME,
CERTIFICATE COURSES INCLUDING CONSULTANCY PART TIME PROGRAMMES
SECTION A

i. PROPOSED COURSE OF STUDY (In order of Preference) 1 HND Computer Science

APPLICANT'S BIODATA

ii. FULL NAMES (Surname First): JOSHUA OLUWAFEMI INUFIN

iii. DATE OF BIRTH 6/1/1999

iv. SEX MALE

v MARITAL STATUS SINGLE

vi HOME TOWN KABBA

vii STATE OF ORIGIN KOGI

viii LGA KABBA/BUNU

NAME AND PERMANENT ADDRESS OF PARENT OR

ix RIDWAN KADUNA
GUARDIAN

x GUARDIAN'S PHONE NO. 08108548540

xi APPLICANT'S PHONE NO. 2348057422510

xii PRESENT HIGHEST QUALIFICATION AND DATE OBTAINED ND COMPUTER SCIENCE-30/11/2022

EDUCATIONAL BACKGROUND (CANDIDATE MUST FILL APPROPPRIATELY)

POST PRIMARY SCHOOL POST SECONDARY SCHOOL

NAME OF SCHOOL : PONEER ADVANCE EDUCATIONAL
NAME OF INSTITUTION: FEDERAL POLYTECHNIC KAURA NAMODA
CONSULT ABUJA
YEAR OF GRADUATION : 01-SEP-2019 YEAR OF GRADUATION : 30/11/2022

EXAMINATION NO.: SSCE/GCE or its equivalent

POST SECONDARY
NABTEB (NECO/NABTEB) O/Level

S/No. SUBJECT GRADE OVERALL GRADE

1 English C4 NATIONAL DIPLOMA-LOWER CREDIT
2 Mathematics B3
JAMB No.
3 Physics C4
4 Chemistry C5
5 Biology C5
6 Civic Education C6
7 Bible Studies/CRK C4

(Photocopies of all Certificates, Diploma, etc including evidence of State of Origin, Declaration of Age/Birth Certificate must
accompany this form as a condition for consideration for admission)

xiv DECLARATION OF APPLICANT

I make this declaration of oath and with the believe that :-
A. The particulars given on this form are to the best of my knowlegde correct
B. If admitted to the Polytechnic i shall regard myself bound by the regulation of the Polytechnic
C. If at any time the Polytechnic is reasonably satisfied that any of the information I have given on this form is fake or incorrect I
will be required to withdraw from the Polytechnic or be liable to prosecution or both

Name JOSHUA OLUWAFEMI INUFIN Sign_________________________________Date 10/1/2024

SECTION B
To be completed by principal of the applicant's present /last school or collage; or Employer if candidate is in employment
i. Comment on Candidate' character _____________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

ii State Candidate's Rank and Salary ______________________________________________________________________________________________________

iii I declare that the information given are to the best of my knowledge correct _____________________________________________________

___________________________________________________________________________________________________________________________________________

Name: _______________________________________________________________________________________

Official Stamp Signature: ______________________________________________________________________________________

Date: ____________________ Title/Rank: ______________________________________________________________________________________

Address: ______________________________________________________________________________________

SECTION C

FOR POLYTECHNIC USE ONLY

THE FOLLOWING PARTICULARS HAVE BEEN RECIEVED
i. Primary School Leaving Certificate
ii. Secondry School Certificate, GCE, Grade II, Statement of result or equivelent
iii. School Testimonial/Leaving Certificate
iv. Local Government Area Indigene Certificate
v. Birth Certificate or Statutory Declaration of age
vi. Medical Certificate of Fitness
vii. Others

1. _____________________________________________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________________________________________

CERTIFICATE and other documents checked and verified by me:_

NAME:__________________________________________________ SIGN____________________________________DATE___________________________________________

Student's Registration No. ( if Admitted ) ______________________________________________________________________________________________________

Remark by Department (if any)__________________________________________________________________________________________________________________

Remarks by Registrar (if any)____________________________________________________________________________________________________________________