Private Mail Bag

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
28 July, 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.
Please add evidence of payment(eg. Pay in Slip) to this document when posting.

Personal Information NB: The name and its arrangement on this application MUST be
EXACTLY same as on certificate / Result slip.
Applicant ID: 21470644
Admission Group: Undergraduate International Applicants
Application Mode: Others

Title: Mr.
Surname: ADEYEMO

FirstName: TEMITOPE
Is this your correct
passport-size Middle/Other Names: SAMUEL
photograph?
Date of Birth: 07 May, 2005
Proceed to submit your Gender: Male
application if your
answer is 'YES' Marital Status: Single

Home Country: Nigeria

You could be denied
admission if you upload Home Region: OTHERS
Inappropriate Passport-
size photograph. Phone Number: +234 9013832674
Email Address: ADEYEMOTEMITOPEREAL@GMAIL.CO
This shall be used in M
producing your ID
CARD upon Postal Address: JANTA AREA 233003 OSUN STATE
registration. NIGERIA

Residential Address: JANTA AREA OSUN STATE

Guardians Information
Name: Mr. AYOBAMI ADEYEMO
Relation to Applicant: Brother
Occupation: BUSINESS MAN
Phone Number: +234 8132755217
Email Address: ADEYEMOAYO3331@GMAIL.COM
Address: JANTA AREA IFON OSUN OSUN STATE
NIGERIA

Programme Choices

Page 1 of 3
Choice Programme Stream
First BSC. COMPUTER SCIENCE (203) Regular
Second BSC. COMPUTER SCIENCE (203) Regular
Third BSC. COMPUTER SCIENCE (203) Regular
Fourth BSC. AGRICULTURE (101) Regular

Educational Background

Institution Programme Pursued Duration

ARANYIN HIGH SCHOOL, ARANYIN SCIENCE April, 2016 - July, 2021

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

Exam Type Sitting Exam Year Index Number

NECO May/June (School) 2021 2110312143BD
(NIGERIA
only)

Subject Grade
ANIMAL HUSBANDARY C4
BIOLOGY C4
CHEMISTRY C5
ECONOMICS C4
ENGLISH C6
MATHEMATICS B3
PHYSICS C4
YORUBA C5

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.

Page 2 of 3
 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, MR. ADEYEMO TEMITOPE SAMUEL (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

28 Jul, 2023 21470644 COMP/1283 ..........................................

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 MR. ADEYEMO
TEMITOPE SAMUEL who 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..........................................................................................................

Page 3 of 3