Handling fee receipt..........................

GWERU POLYTECHNIC
APPLICATION FORM: ACADEMIC YEAR 20…
Students to complete Part A to Part D. Part E is for official use

PART A
Students Name in full: Mr/Mrs/Miss:.......................................................................................................
National I.D. Number:..................................................... Date of Birth:..................................................
Nationality:..................................................................... Sex:...................................................................
Postal Address:.........................................................................................................................................
..................................................................................................................................................................
.....................................................................................Phone:.................................................................
Next of Kin:………………………………………...……………………………………………………………………………………………….
Residential Address: ................................................................................................................................
..................................................................................................................................................................
.....................................................................................Phone:..................................................................
PART B: Course Enrolled for:....................................................................................................................
PART C: Academic Qualifications & Last School Attended:......................................................................
“O” Level "A” Level
Subject Year Grade Subject Year Grade

PART D: Professional Qualifications

Qualification Year Grade College/Institution

Student’s Signature: …………………………………. Date:……………………………………

PART E (for official use only)
Student Number:.........................................................................
Original Qualifications checked by:
HOD:........................................................................................... Signature:............................................
Registration Fee Paid:.................................................................. Handling Fee:......................................
Caution Fee Paid:......................................................................... Library Levy Paid:................................
Tuition Fee Paid:........................................................................... Amenities Fees Paid:..........................
Hostel Fee Paid:............................................................................ Graduation Fee Paid:.........................

Checked by:..................................................Signature:....................................... Date Stamp: