AFFIX

PASSPORT
SENATOR WASIU SANNI ESHILOKUN PHOTOGRAPH
LAGOS CENTRAL
USE GUM PLEASE
Educational Support Programme
2023/2024 SCHOLARSHIP FORM
SINCE WHEN
OLD NEW

PERSONAL DATA LASSRA NO

Surname:
First Name: Other Names
Sex: Please use functional email address
Email:
Phone Number:
State Of Origin:
Father’s Name:
Mother’s Name:
Mother’s Maiden Name:
Parent’s Phone Number:
Home Address:
CGPA
Name Of Institution:
Address:
Level: Course:
Matric Number
Year Of Admission: Year Of Completion:
PVC No.
Ward Polling Unit
REQUIREMENTS:
1. Photocopy of WAEC, GCE OR NECO RESULT (Original to be sighted and certificate to be provided after \2 years)
2. Birth certificate of the applicant
3. Letter of introduction from any Oba from Lagos Central Senatorial District or Head of the Chieftaincy
Ruling House or Head of family.
4. Passport Photography and Photocopy of LASSRA certificate.
5. Letter or Identification Card signed by the Chairman from your Local Government.
6. Admission Letter from a Government owned Tertiary Institution in Nigeria.
7. Transcripts of examinations of all beneficiaries.
8. Photocopy Permanent Voters Card
INSTITUTIONAL USE
That theAdmission Status of the applicant is correct.
To be filled by the Student Affairs Officer
Name:
Name of Institution:
Phone Number
Signature & Stamp: Date:
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