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KWAME NKRUMAH UNIVERSITY OF University Post Office

SCIENCE AND TECHNOLOGY Kumasi-Ghana

+233 3220 60444

+233 3220 61831
Online Application Form 2023/2024 Academic Year ONLY
01 January, 0001

Please Indicate Your Envelope Number At The Back Of Your EMS Envelope
SUBMIT TWO (2) COPIES OF THIS FORM
Add photocopies of all related documents, certificates & results [Application is
incomplete without these]
Keep a copy of this printout for any future enquiry.

Personal Information NB: The name and its arrangement on this application MUST be
EXACTLY same as on certificate / Result slip.
Applicant ID: 21045996
Admission Group: Applying as Undergraduate Ghanaian
Students for (BA/BSC/BFA/LLB ETC.)
Application Mode: GHANA SSSCE/WASSCE

Title: Mr.
Surname: ISSAH

FirstName: MOHAMMED
Is this your correct
passport-size Middle/Other Names:
photograph?
Date of Birth: 15 March, 2005
Proceed to submit your Gender: Male
application if your
answer is 'YES' Marital Status: Single

Home Country: Ghana

You could be denied
admission if you upload Home Region: UPPER EAST
Inappropriate Passport-
size photograph. Phone Number: +233 546610003
Email Address: ISSAHMOHAMMED05466@GMAIL.COM
This shall be used in
producing your ID Postal Address: C/O ISSAH MOHAMMED P. O. BOX 690
CARD upon DANSOMAN GHANA
registration.

Residential Address: F291 BAZA STREET GD-268-9961

AMRAHIA

Guardians Information
Name: Mrs. ADIZA JAI
Relation to Applicant: Mother
Occupation: BUSINESSWOMAN
Phone Number: +233 549576765
Email Address:
Address: JAI ADIZA F291 BAZA STREET
DANSOMAN ESTATE GHANA

Programme Choices
Choice Programme Stream

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Educational Background

Institution Programme Pursued Duration

ISLAMIC SNR HIGH SCHOOL GENERAL SCIENCE October, 2020 - October, 2023

Exam Result Ensure this information is accurate [Exam Year] and [Index Number]

Exam Type Sitting Exam Year Index Number

WASSCE May/June (School) 2023 0050116527
(GHANAIAN)

Subject Grade
Mathematics (Core) B2
Integrated Science B3
Social Studies B3
English Language B2
Biology B3
Physics B3
Chemistry B3
Mathematics (Elective) B2

Please Note That EXAMINATION DESCRIPTION (ie. Index No., Year of exam, etc.) will be used to
pick RESULTS directly from The West African Examination Council(WAEC). CHECK For its Validity.

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

I, MR. ISSAH MOHAMMED (Exact name and arrangement on my certificate/result slip) certify
that the information provided above is valid and will be held personally responsible for its
authenticity and will bear any consequences for any invalid information provided

Date of Print Application ID Envelope Number Signature of Applicant

18 Jan, 2024 21045996 ..........................................

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Corroborative Declaration

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE YOU ENDORSE THIS FORM

1. This Declaration should be signed by a person of high integrity and honour who must also endorse at least
one of the candidate's passport-size photographs on the reverse side and also satisfy himself/herself that the
examination Description and grades indicated on the form by the applicant are correct and genuine.

2. The application will not be valid if the declaration below is not signed.

3. If the declaration proves to be false, the application shall be rejected; if the falsity is detected after
admission, the student shall be dismissed.

I hereby declare that the photograph endorsed by me is the true likeness of the applicant MR. ISSAH
MOHAMMED who is personally known to me. I have inspected his/her certififcates and EXAMINATION
DESCRIPTION against the result indicated on the form and I am satisfied that they are correct and genuine
and the name that appears on them is EXACTLY the same as that by which he/she is officially/personally
known to me.

SIGNATURE.............................................................................................................................................

DATE........................................................................................................................................................

NAME (BLOCK LETTERS).....................................................................................................................

OCCUPATION.........................................................................................................................................

POSITION.................................................................................................................................................

CONTACT NUMBER(S) .......................................................................................................................

ADDRESS & OFFICIAL STAMP..........................................................................................................

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