JOINT ADMISSIONS AND MATRICULATION BOARD

Unified Tertiary Matriculation Examination (UTME)

Application Form Sheet Template Recent Passport
Photo
Not older than
(3 months)
First Name Middle Name Surname (Family Name)

Date of Birth: Sex (Male or Female):

Day/Month/Year

Marital Status (Single/Married/Divorce): Disabilities (Blind/Deaf/Physical Handicap):

Postal Address:
Address Town/State State /Country
Note: Address, Town and State for Address in Nigeria while Address, State and Country for Address Outside Nigeria

Email: GSM No:

Nationality (Nigerian/Non Nigerian):

State of Origin: Local Govt. Area:

State of Exam Town: Exam Town:

First Most Preferred Institution (Degree/ND/NCE):

Course:

First More Preferred Institution (Degree/ND/NCE):

Course:

First Preferred Institution (Degree/ND/NCE):

Course:

Second Most Preferred Institution (Degree/ND/NCE):

Course:

Second More Preferred Institution (Degree/ND/NCE):

Course:

Second Preferred Institution (Degree/ND/NCE) :

Course:

O’Level Type (e.g. WAEC, NECO, GCE London etc)

UTME Subjects O’Level Subjects Grades

1. Use of English 1.
2.
2.
3.
3.
4.
4.
5.
NB: Your Biometrics (Thumb Prints) shall be 6.
captured at the point of creating Account. 7.
8.
Number of Sittings (Maximum of 2)