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PENTECOST UNIVERSITY
ONLINE APPLICATION FORM FOR UNDERGRADUATE ADMISSION

Print Application Form

Form No.: PUC20221123723 Programme: Certificate in Mortuary Science and Funeral Studies Session: Regular

Student's Information
Surname: PERNARH Title: Mr:
First Name JAMES Other Names: KABU
Gender Male Date of Birth: 16-08-1993
Place of Birth: Accra Home Town: Tortime Kope
Region/State: Volta Nationality: Ghana
Religion: Christianity Marital Status: Single

Contact Information
Permanent Home
Hn. A 20/14
Address:
Current Address Hn. A 20/14
Telephone: 0544126125, 0544121627
Email:

Guardian/Sponsor and Other Information

Name of Parent/Guardian/Sponsor: James Kabu
Occupation: Teaching
Physically challenged? No,
Are you currently in employment?
Type or Nature of Employment:
Employer Name:
Employer Address:

Educational Background
No. Name of School Dates Qualifications
1. Holy Trinity Cathedral 2011 - 2014 WASSCE
2. -
3. -
4. -
5. -
6. -

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Examination Details
WASSCE
Index Number Year Month Subjects Grade Sitting
0010104233 2014 June 100-Core Mathematics C6 1st
0010104233 2014 June 101-English Language B3 1st
0010104233 2014 June 102-Integrated Science C4 1st
0010104233 2014 June 104-Social Studies B2 1st
0010104233 2014 June 125-Economics D7 1st
0010104233 2014 June 133-French A1 1st
0010104233 2014 June 139-Government B2 1st
0010104233 2014 June 148-Literature in English B3 1st
Other Results
Index Number Year Month Subjects Grade Sitting

Declaration
I PERNARH JAMES KABU declare that all the particulars provided above is valid and will be held personally responsible for
its authenticity

Date: _________________ Student's Signature: _________________

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 grades indicated
on the form by the applicant are genuine.
2. The application will not be valid if the decalration 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 PERNARH JAMES KABU who is
personally known to me. I have inspected his/her certificates against the results indicated on the form and I am satisfied that they
are genuine and the name that appears on them is the same as that by which he/she is officially/personally known to me.

Signature: ______________________________________________________
Date: ______________________________________________________
Name(BLOCK LETTERS) ______________________________________________________
Occupation: ______________________________________________________
Position ______________________________________________________
Address & Official Stamp ______________________________________________________
Telephone No. ______________________________________________________

Date of Print Form Number Signature of Applicant

30-04-2024 PUC20221123723 _________________

Important Information
A. An applicant who makes a false declaration or withholds relevant information may be refused admission.

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If He/She has already been enrolled in the University, He/She would be asked to withdraw.
B. An applicant are to submit the following during the fresh students orientation to the Academic Registry:
1. Completed form
2. Certified photocopies of result slips or certificates.
3. Two recent passport-size photographs (one of which should be endorsed by a Senior Public Servant or a Legal Practitioner)

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