P.M.B.

13 Auchi, Edo State

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Application No.: SLT/ND2223/04466 | Jamb Reg. No.:
Application Form 2022/2023
FOR 2022/2023**: Admissions :Evening Studies
 

  This Passport will remain your valid passport while in

Auchipolytechnic

Course of Study Information  

Proposed Programme of Study:
Proposed Course of Study:
Department:
Application Number:
Personal & Contact Detail
ND
SCIENCE LABORATORY TECH.
SCIENCE LABORATORY TECH.
SLT/ND2223/04466
 

Surname EHIAGWINAN
Other Names FAVOUR EJEHIYOAKHIAN
Maiden Names (For Female only)
Date of Birth 11 November,2002
Sex Female
Marital Status Single
Nationality NIGERIAN
State EDO STATE
L.G.A
Edo State L.G.A. Esan North-East
Permanent Home Address AMEDU STREET, OPPOSITE ACC, IRRUA
Present Postal Address AMEDU STREET, OPPOSITE ACC, IRRUA
Name & Address of Parents/Guardian MR. AND MRS. EHIAGWINA
Occupation of Parents/Guardin Trading
Parent Phone Number 08137053022
   
Educational Qualification  
Grade
S/N Subject Examination Center No. Exam No. Exam Date Year of Exam.
Obtained

1. Economics WAEC/SSCE/GCE 4130303026 4130303026 May/June 2021 A3

2. Government A2
3. Civic Education A1
4. English Language C4
5. Mathematics A1
6. Biology A2
 7. Chemistry A2
8. Physics A1

Number of Certificates
One
Combined:

   
Other School / Certificates Obtained ( HND and POST-HND Candidates only e.g Auchi Poly ND)
School / Certificate Subject Area Grade Year of Graduation Matric Number GPA

 
Previous Jamb Exam Details
Jamb Registration Number
Year Examination was taken
Jamb Exam Center
Jamb Exam Result
Subject 1 Score
Subject 2 Score
Subject 3 Score
Subject 4 Score
Total Jamb Score
First Choice of School Chosen in
JAMB
First Choice of Course Chosen in
JAMB
Second Choice of School Chosen in
JAMB
Second Choice of Course Chosen in
JAMB
   
Other Information
Reason for choice of Course: CAREER DEVELOPMENT
Have you been a student in a similar institution before? If so, give the name of the institution, the period of attendance,
the course of study and reason for leaving. : NO 
Who will be responsible for your fees? :My parents
Have you been convicted? If yes, state nature of offence :NO
 
References:
Name Address Phone/Email
MR. AND MRS. EHIAGWINA  AMEDU STREET, OPPOSITE ACC, IRRUA  08137053022 
     
     

I hereby declare that the Information given here is to the best of my knowkedge true and correct

Signature: ......................................................................................
Date:..........................................................................