Federal University of Technology, Owerri

VALIDITY FORM - UNDERGRADUATE

ADMISSION

Two copies of this form should be duly completed by all the candidates
admitted in this university and returned with the Letter of Acceptance for
Provisional Admission to THE REGISTRAR (ADMISSIONS) not later than two
weeks from date of issue.

1. COURSE OF STUDY

SCHOOL: HEALTH TECHNOLOGY

DEPARTMENT: ENVIRONMENTAL HEALTH SCIENCE

JAMB REG NO: 202330843297FF

MODE OF ADMISSION (TICK): MERIT SUPPLEMENTARY

2. PERSONAL INFORMATION

SURNAME: UZOMA

OTHERNAMES: GREAT UZOCHUKWU

HOME/PERMANENT ADDRESS: SLOT 28 OLU STREET BY CHOSEN CHURCH PORTHARCOURT ABIA STATE

PHONE NUMBER: 07043265277

POSTAL ADDRESS: (IF DIFFERENT FROM ABOVE): ...................................................................................

DATE OF BIRTH: 2007-01-26

STATE: IMO STATE

LGA: ORU WEST

NATIONALITY: NIGERIA

NAME AND ADDRESS OF PARENT/GUARDIAN: ONYEBUAGU SUNNY UZOMA

PHONE NUMBER OF PARENT/GUARDIAN: 08097752224

EMAIL: onyebuaguzoma@gmail.com

PERSON TO CONTACT IN CASE OF EMERGENCY: ...................................................................................

3. ACCOMODATION

INTEREST IN ON-CAMPUS RESIDENCE INTEREST IN OFF-CAMPUS RESIDENCE

4. EXTRA CURRICULAR ACTIVITIES

SPORTS (STATE THEM) .....................................................

 DECLARATION

I am grateful to the vice chancellor for the admission and hereby undertake as a student of FUTO to observe and comply
with all ordinances and regulations of the University as fas they concern me.

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

FOR OFFICE USE ONLY

Year of Admission: ________________________________________________________________________________________________________

Acceptance/Dev Levy: Paid / UnPaid

Receipt No: ________________________________________________________________________________________________________

Verify By: ________________________________________________________________________________________________________