FORM R/REG.

06

STUDENTS INFORMATION FORM (SIF)

2023-2024 SESSION

1. REGISTRATION NUMBER: 202331372970AF

2. NAME (MR/MRS/MISS) EZE PRINCEWILL UGONNA
SURNAME FIRST NAME MIDDLE NAME

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FORMER SURNAME (IF ANY)

3. SEX Male 4. DATE OF BIRTH 30 06 2005 5. NATIONALITY: Nigeria

DAY MONTH YEAR

6. PLACE OF BIRTH ----------------------------------------------------------------------------------------------------------

TOWN STATE

7. PLACE OF ORIGIN ENUGUEnugu State Udi

TOWN STATE L.G.A

8. MARITAL STATUS (S-SINGLE D-DIVORCED M-MARRIED W-WIDOW)

ENTER APPROPRIATE LETTER

9. RELIGION (C-CHRITIANITY T-TRADITIONAL I-ISLAM O-OTHERS )

ENTER APPROPRIATE LETTER

10. ADDRESS
(A) PERMANENT/HOME ADDRESS NO 9 ADEWALE STREET COKER
11. NEXT OF KIN NAME EZE ANTHONIA
ADDRESS NO 9 ADEWALE STREET COKER
RELATIONSHIP Mother
TELEPHONE 09138203533
12. SPONSOR NAME ENGR EZE CHUKWUDI GABRIEL
ADDRESS NO 9 ADEWALE STREET COKER

13A. MODE OF ENTRY

(FOR UNDERGRADS ONLY) UTME
ENTER APPROPRIATE LETTER R-REMEDIAL U-UME D-DIRECT T-TRANSFER

13B. IF TRANSFER, PREVIOUS UNIVERSITY

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13C. PROGRAMME TYPE (F-FIRST DEGREE D-DIP/CERT H-PG DEGREE )

ENTER APPROPRIATE LETTER

14. HIGHEST QUALIFICATION

(ENTER APPROPRIATE NUMBER)
 (1. SSCE 2. WASC/GCEOL 3. TCIL/ACE 4. HSC/GCE/A/L 5.
ND 6. HND 7. NCE 8. BACHELOR'S DEGREE 9. PGD. 10.
MASTERS 11. PH.D )
12. OTHERS PLEASE SPECIFY-------------------------

15. INSTITUTION WHERE OBTAINED ---------------------------------------- DATE -------------------

16. SUJECT OF FIRST DEGREE -------------------------------------------------------------------------------

(FOR POSTGRADUATE ONLY)

17. YEAR OF ENTRY INTO PRESENT INSTITUTION --------------------------------------------------

18. COLLEGE -----------------------------------------------------------------------------------------------------

19. FACULTY/SCHOOL ----------------------------------------------------------------------------------------

20. DEPARTMENT/INSTITUTE ------------------------------------------------------------------------------

21. QUALIFICATION IN VIEW -------------------------------------------------------------------------------

22. MODE OF STUDY (F-FULL TIME P-PART TIME (DAY))

(ENTER APPROPRIATE LETTER) (W-WEEKED E- EVENING)
(S-SANDWICH/LONG VACATION)
(O-OCCASIONAL X-EXCHANGE)
C-CORRESPONDENCE

23. NORMAL COURSE DURATION ----------------------------------------------------------------------

24. EXTRA CURRICULAR ACTIVITIES -----------------------------------------------------------------

25. HEALTH STATUS

NORMAL DISABLE

IF DISABLED, STATE TYPE -------------------------------------------------------------------------------------

IF SPECIAL MEDICATIONS IS REQUIRED, STATE TYPE ------------------------------------------------

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SIGNATURE OF STUDENT Date