Application Form

This form is used for submission of application for enrolment at the NVU. Entries on this form should be transferred to the NVU
Board for check of compliance with the enrolment criteria. Fields marked blue indicate NVU requested information and shall not be
filled, whereas yellow fields are optional.

1. General Information

Name(s): OBIDIKE IFEANYICHUKWU GEORGE

Date of birth: (dd/mm/yy) 11/11/2004 Place of birth: (city/country) Nigeria

Citizenship(s): Nigerian Gender: (male/female) Male

Address: 14 seltex road Port Harcourt, Rivers state

Ifeanyigeorgembj16@gmail.co
Phone: +2347081451333 E-mail:
m

Skype: +2347081451333 E-mail (other):

2. Information about desired program

Name of the program/

Medicine
qualification (major):

Information below is optional:

Estimated minor/
Subfield of specialization:
sub-concentration:

Special competences: Other:

3. Information about Prior Education

3.1 General (Secondary) education

Marist Brothers’
Name of the institution: Qualification: science
Juniorate

Starting date: 15/01/2015 Date of accomplishment: 13/09/2020

Address of the main campus

Uturu, Isuikwuato local government area, Abia state, Nigeria.
of the Institution:
Home country entitlement to
School leaving certificate
pursue higher education
number:
(yes/no):
3.2 Higher education (to be filled in case of enrolment request at masters or PhD programs, or if the applicant has conducted at
least part of BA education at his/her home institution)

In case of several qualifications please add additional table(s)as many times as needed:

Name of the institution: Received qualification:

Duration in years: (ECTS) Credits earned:

Starting date: Date of accomplishment:

Address of the main campus

of the Institution:
Home country entitlement to
Diploma/certificate number: pursue respective level of
higher education (yes/no):

4. Information about language proficiency

English: (A-highest, B,C,D, E- Refreshment course needed

A No
basic) (yes/no):
Certificate/confirmation
Duration of study (years): 6 years No
available (yes/no):

5. Motivation (not more than 500 words)

I am a secondary school graduate and ready to join college to further my studies, medicine is a program that throughout my
studies I have built interest in and I would like to specialize in a number of its disciplines. Biology science, chemistry and physics I
have always desired to reap the benefits that come along with acquiring the knowledge and skills in the field. In my secondary
school education biology has been my favourite subject.
My career objective is to become an expert in the medical field. Therefore, it was significant for me to concentrate more on a
subject that helps me to reach my carrier goals. In my examination biology has always emerged as one of the subjects I did best.
This has always given me the zeal to work hard to achieve my objective.
It is my understanding that studying medicine in the college shall open my mind and instil skills in me that are necessary to
have excellent prowess in medicine. Through my research, I have found this college to have students with very good quality
degrees in medicine. I hope to hear from you soon, thanks for your time.

6. Bank Account Information (for refund – if required) – IBAN with Intermediary (please include SWIFT)

7. Comment or further information

8. Name of Intermediary institution(s)/Agent(s) supporting your application:

Name:

Phone: E-mail:

9. Information about preferred Medical Licensing examination (only for MD students)

Please indicate if you want to take any of the following Medical Licensing exams after accomplishing the study
course:

USMLE (USA) √ SMC (USA)

PLAB (UK) AMC (Australia)

FMGE (INDIA) Other:

10. Confirmation and signature:

I hereby confirm correctness and accuracy of submitted information and awareness that the provision of incorrect or
inaccurate information may cause refusal of enrolment.

Signature:_______________________________________________________ Date: 17/03/2022_________________