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KWAME NKRUMAH UNIVERSITY OF University Post Office

SCIENCE AND TECHNOLOGY Kumasi-Ghana

+233 3220 60444

+233 3220 61831
Online Application Form 2023/2024 Academic Year ONLY
10 October, 2023

Please Indicate Your Envelope Number At The Back Of Your EMS Envelope
SUBMIT TWO (2) COPIES OF THIS FORM
Add photocopies of all related documents, certificates & results [Application is
incomplete without these]
Keep a copy of this printout for any future enquiry.

Personal Information NB: The name and its arrangement on this application MUST be
EXACTLY same as on certificate / Result slip.
Applicant ID: 20997170
Admission Group: Applying as Undergraduate Ghanaian
Students for (BA/BSC/BFA/LLB ETC.)
Application Mode: GHANA SSSCE/WASSCE

Title: Miss
Surname: REYNOLDS

FirstName: GIFTY
Is this your correct
passport-size Middle/Other Names: NANA YAA
photograph?
Date of Birth: 27 October, 2005
Proceed to submit your Gender: Female
application if your
answer is 'YES' Marital Status: Single

Home Country: Ghana

You could be denied
admission if you upload Home Region: CENTRAL
Inappropriate Passport-
size photograph. Phone Number: +233 551830426
Email Address: REYNANAGIFTY101@GMAIL.COM
This shall be used in
producing your ID Postal Address: C/O MADAM OFEEI BARBARA, BENKUM
CARD upon SHS P. O. BOX 49 LARTEH AKUAPEM
registration. GHANA

Residential Address: 15 ASTER CREDENT GM-147-9597

KOVTTAM ESTATE OYARIFA - ACCRA

Guardians Information
Name: Mrs. MARIE REYNOLDS
Relation to Applicant: Grandmother
Occupation: RETIRED BANKER
Phone Number: +233 249687706
Email Address: MARIEVREYNOLDS@YAHOO.CO.UK
Address: 15 ASTER CRESCENT KOVTTAM
ESTATE OYARIFA ACCRA GHANA

Programme Choices

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Choice Programme Stream
First BSC. COMPUTER SCIENCE (203) Regular
Second BSC. CHEMISTRY (104) Regular
Third BSC. FOOD SCIENCE AND TECHNOLOGY Regular
(547)
Fourth BSC. AGRICULTURE (101) Regular

Educational Background

Institution Programme Pursued Duration

BENKUM SNR HIGH SCHOOL SCIENCE September, 2021 - September,
2023

Exam Result Ensure this information is accurate [Exam Year] and [Index Number]

Exam Type Sitting Exam Year Index Number

WASSCE May/June (School) 2023 1020403138
(GHANAIAN)

Subject Grade
Mathematics (Core) Awaiting
Integrated Science Awaiting
Social Studies Awaiting
English Language Awaiting
Geography Awaiting
Physics Awaiting
Chemistry Awaiting
Mathematics (Elective) Awaiting

Please Note That EXAMINATION DESCRIPTION (ie. Index No., Year of exam, etc.) will be used to
pick RESULTS directly from The West African Examination Council(WAEC). CHECK For its Validity.

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 IMPORTANT

AN APPLICANT WHO MAKES A FALSE STATEMENT OR WITHHOLDS RELEVANT

INFORMATION MAY BE REFUSED ADMISSION. IF HE HAS ALREADY COME INTO THE
UNIVERSITY, HE WILL BE WITHDRAWN.

DECLARATION

I, MISS REYNOLDS GIFTY NANA YAA (Exact name and arrangement on my certificate/result
slip) certify that the information provided above is valid and will be held personally responsible for
its authenticity and will bear any consequences for any invalid information provided

Date of Print Application ID Envelope Number Signature of Applicant

10 Oct, 2023 20997170 CENG/0738 ..........................................

Corroborative Declaration

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE YOU ENDORSE THIS FORM

1. This Declaration should be signed by a person of high integrity and honour who must also endorse at least
one of the candidate's passport-size photographs on the reverse side and also satisfy himself/herself that the
examination Description and grades indicated on the form by the applicant are correct and genuine.

2. The application will not be valid if the declaration below is not signed.

3. If the declaration proves to be false, the application shall be rejected; if the falsity is detected after
admission, the student shall be dismissed.

I hereby declare that the photograph endorsed by me is the true likeness of the applicant MISS REYNOLDS
GIFTY NANA YAAwho is personally known to me. I have inspected his/her certififcates and
EXAMINATION DESCRIPTION against the result indicated on the form and I am satisfied that they are
correct and genuine and the name that appears on them is EXACTLY the same as that by which he/she is
officially/personally known to me.

SIGNATURE.............................................................................................................................................

DATE........................................................................................................................................................

NAME (BLOCK LETTERS).....................................................................................................................

OCCUPATION.........................................................................................................................................

POSITION.................................................................................................................................................

CONTACT NUMBER(S) .......................................................................................................................

ADDRESS & OFFICIAL STAMP..........................................................................................................

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