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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
22 December, 2023

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: 21020737
Admission Group: Applying as Undergraduate Ghanaian
Students for (BA/BSC/BFA/LLB ETC.)
Application Mode: GHANA SSSCE/WASSCE

Title: Mr.
Surname: KYEREH

FirstName: EBENEZER
Is this your correct
passport-size Middle/Other Names: OSEI
photograph?
Date of Birth: 10 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: CENTRAL
Inappropriate Passport-
size photograph. Phone Number: +233 555840301
Email Address: EKYEREH16@GMAIL.COM
This shall be used in
producing your ID Postal Address: NYAKROM SENIOR HIGH TECHNICAL
CARD upon SCHOOL. BOX 52 AGONA NYAKROM
registration. GHANA

Residential Address: CO-0002-8511

Guardians Information
Name: Mr. NICHOLAS KYEREH
Relation to Applicant: Father
Occupation: TRADER
Phone Number: +233 246256786
Email Address:
Address: RESURRECTED CHRIST TABERNACLE
P.O BOX SW380 AGONA SWEDRU
GHANA

Programme Choices

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Choice Programme Stream
First BSC. ELECTRICAL/ELECTRONIC ENG. Regular
(OBUASI CAMPUS) (199)
Second BSC. GEOLOGICAL ENG. (737) Regular
Third BSC. GEOLOGICAL ENG. (OBUASI CAMPUS) Regular
(226)
Fourth BSC. MECHANICAL ENG. (OBUASI CAMPUS) Regular
(1421)

Educational Background

Institution Programme Pursued Duration

NYAKROM SENIOR HIGH SCHOOL GENERAL SCIENCE March, 2021 - September, 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 0030901634
(GHANAIAN)

Subject Grade
Mathematics (Core) A1
Integrated Science B3
Social Studies A1
English Language B2
Biology B3
Physics C4
Chemistry B2
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.

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 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. KYEREH EBENEZER OSEI (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

31 Dec, 2023 21020737 ELEC/0821 ..........................................

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. KYEREH
EBENEZER OSEI 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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