Application for Admission

Please fill in all required fields accurately. All information provided will be verified.

Programme Applied For *

Perioperative Nursing Programme

Critical Care Nursing Programme

Personal Data

Full Name *

Age *

Sex *

Marital Status *

Date of Birth *

Nationality *

State of Origin *

Contact Address *

GSM Number *

Email *

Next of Kin

Full Name *

Relationship *

Phone Number *

Address *

Professional Nursing Education

Other Educational Qualifications

Working Experience

Sponsor

Name and Address of Sponsor

Referees (Two)

Referee 1 - First Name

Referee 1 - Surname

Referee 1 - Phone

Referee 1 - Email

Referee 2 - First Name

Referee 2 - Surname

Referee 2 - Phone

Referee 2 - Email

Passport Photograph

Upload Passport (White Background, 2x2) * Max size: 2MB. Format: JPG or PNG

I attest that all the information given above are correct and I understand that any false information detected will render this application void even after admission.