Phone First Name Last Name Other Name Date of Birth Gender Male Female Telephone Email Address Nationality * Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe State of Origin * Abia Adamawa Akwa Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Enugu Edo Ekiti Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nasarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara Local Government * Abadam Abaji Abak Abakaliki Aba North Aba South Abeokuta North Abeokuta South Abi Aboh Mbaise Abua/Odual Adavi Ado Ekiti Ado-Odo/Ota Afijio Afikpo North Afikpo South Agaie Agatu Agwara Agege Aguata Ahiazu Mbaise Ahoada East Ahoada West Ajaokuta Ajeromi-Ifelodun Ajingi Akamkpa Akinyele Akko Akoko-Edo Akoko North-East Akoko North-West Akoko South-West Akoko South-East Akpabuyo Akuku-Toru Akure North Akure South Akwanga Albasu Aleiro Alimosho Alkaleri Amuwo-Odofin Anambra East Anambra West Anaocha Andoni Aninri Aniocha North Aniocha South Anka Ankpa Apa Apapa Ado Ardo Kola Arewa Dandi Argungu Arochukwu Asa Asari-Toru Askira/Uba Atakunmosa East Atakunmosa West Atiba Atisbo Augie Auyo Awe Awgu Awka North Awka South Ayamelum Aiyedaade Aiyedire Babura Badagry Bagudo Bagwai Bakassi Bokkos Bakori Bakura Balanga Bali Bama Bade Barkin Ladi Baruten Bassa Bassa Batagarawa Batsari Bauchi Baure Bayo Bebeji Bekwarra Bende Biase Bichi Bida Billiri Bindawa Binji Biriniwa Birnin Gwari Birnin Kebbi Birnin Kudu Birnin Magaji/Kiyaw Biu Bodinga Bogoro Boki Boluwaduro Bomadi Bonny Borgu Boripe Bursari Bosso Brass Buji Bukkuyum Buruku Bungudu Bunkure Bunza Burutu Bwari Calabar Municipal Calabar South Chanchaga Charanchi Chibok Chikun Dala Damaturu Damban Dambatta Damboa Dandi Dandume Dange Shuni Danja Dan Musa Darazo Dass Daura Dawakin Kudu Dawakin Tofa Degema Dekina Demsa Dikwa Doguwa Doma Donga Dukku Dunukofia Dutse Dutsi Dutsin Ma Eastern Obolo Ebonyi Edati Ede North Ede South Edu Ife Central Ife East Ife North Ife South Efon Egbado North Egbado South Egbeda Egbedore Egor Ehime Mbano Ejigbo Ekeremor Eket Ekiti Ekiti East Ekiti South-West Ekiti West Ekwusigo Eleme Emuoha Emure Enugu East Enugu North Enugu South Epe Esan Central Esan North-East Esan South-East Esan West Ese Odo Esit Eket Essien Udim Etche Ethiope East Ethiope West Etim Ekpo Etinan Eti Osa Etsako Central Etsako East Etsako West Etung Ewekoro Ezeagu Ezinihitte Ezza North Ezza South Fagge Fakai Faskari Fika Fufure Funakaye Fune Funtua Gabasawa Gada Gagarawa Gamawa Ganjuwa Ganye Garki Garko Garun Mallam Gashaka Gassol Gaya Gayuk Gezawa Gbako Gboko Gbonyin Geidam Giade Giwa Gokana Gombe Gombi Goronyo Grie Gubio Gudu Gujba Gulani Guma Gumel Gummi Gurara Guri Gusau Guzamala Gwadabawa Gwagwalada Gwale Gwandu Gwaram Gwarzo Gwer East Gwer West Gwiwa Gwoza Hadejia Hawul Hong Ibadan North Ibadan North-East Ibadan North-West Ibadan South-East Ibadan South-West Ibaji Ibarapa Central Ibarapa East Ibarapa North Ibeju-Lekki Ibeno Ibesikpo Asutan Ibi Ibiono-Ibom Idah Idanre Ideato North Ideato South Idemili North Idemili South Ido Ido Osi Ifako-Ijaiye Ifedayo Ifedore Ifelodun Ifelodun Ifo Igabi Igalamela Odolu Igbo Etiti Igbo Eze North Igbo Eze South Igueben Ihiala Ihitte/Uboma Ilaje Ijebu East Ijebu North Ijebu North East Ijebu Ode Ijero Ijumu Ika Ika North East Ikara Ika South Ikeduru Ikeja Ikenne Ikere Ikole Ikom Ikono Ikorodu Ikot Abasi Ikot Ekpene Ikpoba Okha Ikwerre Ikwo Ikwuano Ila Ilejemeje Ile Oluji/Okeigbo Ilesa East Ilesa West Illela Ilorin East Ilorin South Ilorin West Imeko Afon Ingawa Ini Ipokia Irele Irepo Irepodun Irepodun Irepodun/Ifelodun Irewole Isa Ise/Orun Iseyin Ishielu Isiala Mbano Isiala Ngwa North Isiala Ngwa South Isin Isi Uzo Isokan Isoko North Isoko South Isu Isuikwuato Itas/Gadau Itesiwaju Itu Ivo Iwajowa Iwo Izzi Jaba Jada Jahun Jakusko Jalingo Jama'are Jega Jema'a Jere Jibia Jos East Jos North Jos South Kabba/Bunu Kabo Kachia Kaduna North Kaduna South Kafin Hausa Kafur Kaga Kagarko Kaiama Kaita Kajola Kajuru Kala/Balge Kalgo Kaltungo Kanam Kankara Kanke Kankia Kano Municipal Karasuwa Karaye Karim Lamido Karu Katagum Katcha Katsina Katsina-Ala Kaura Kaura Namoda Kauru Kazaure Keana Kebbe Keffi Khana Kibiya Kirfi Kiri Kasama Kiru Kiyawa Kogi Koko/Besse Kokona Kolokuma/Opokuma Konduga Konshisha Kontagora Kosofe Kaugama Kubau Kudan Kuje Kukawa Kumbotso Kumi Kunchi Kura Kurfi Kusada Kwali Kwande Kwami Kware Kwaya Kusar Lafia Lagelu Lagos Island Lagos Mainland Langtang South Langtang North Lapai Lamurde Lau Lavun Lere Logo Lokoja Machina Madagali Madobi Mafa Magama Magumeri Mai'Adua Maiduguri Maigatari Maiha Maiyama Makarfi Makoda Malam Madori Malumfashi Mangu Mani Maradun Mariga Makurdi Marte Maru Mashegu Mashi Matazu Mayo Belwa Mbaitoli Mbo Michika Miga Mikang Minjibir Misau Moba Mobbar Mubi North Mubi South Mokwa Monguno Mopa Muro Moro Moya Mkpat-Enin Municipal Area Council Musawa Mushin Nafada Nangere Nasarawa Nasarawa Nasarawa Egon Ndokwa East Ndokwa West Nembe Ngala Nganzai Ngaski Ngor Okpala Nguru Ningi Njaba Njikoka Nkanu East Nkanu West Nkwerre Nnewi North Nnewi South Nsit-Atai Nsit-Ibom Nsit-Ubium Nsukka Numan Nwangele Obafemi Owode Obanliku Obi Obi Obi Ngwa Obio/Akpor Obokun Obot Akara Obowo Obubra Obudu Odeda Odigbo Odogbolu Odo Otin Odukpani Offa Ofu Ogba/Egbema/Ndoni Ogbadibo Ogbaru Ogbia Ogbomosho North Ogbomosho South Ogu/Bolo Ogoja Ogo Oluwa Ogori/Magongo Ogun Waterside Oguta Ohafia Ohaji/Egbema Ohaozara Ohaukwu Ohimini Orhionmwon Oji River Ojo Oju Okehi Okene Oke Ero Okigwe Okitipupa Okobo Okpe Okrika Olamaboro Ola Oluwa Olorunda Olorunsogo Oluyole Omala Omuma Ona Ara Ondo East Ondo West Onicha Onitsha North Onitsha South Onna Okpokwu Opobo/Nkoro Oredo Orelope Oriade Ori Ire Orlu Orolu Oron Orsu Oru East Oruk Anam Orumba North Orumba South Oru West Ose Oshimili North Oshimili South Oshodi-Isolo Osisioma Osogbo Oturkpo Ovia North-East Ovia South-West Owan East Owan West Owerri Municipal Owerri North Owerri West Owo Oye Oyi Oyigbo Oyo Oyo East Oyun Paikoro Pankshin Patani Pategi Port Harcourt Potiskum Qua'an Pan Rabah Rafi Rano Remo North Rijau Rimi Rimin Gado Ringim Riyom Rogo Roni Sabon Birni Sabon Gari Sabuwa Safana Sagbama Sakaba Saki East Saki West Sandamu Sanga Sapele Sardauna Shagamu Shagari Shanga Shani Shanono Shelleng Shendam Shinkafi Shira Shiroro Shongom Shomolu Silame Soba Sokoto North Sokoto South Song Southern Ijaw Suleja Sule Tankarkar Sumaila Suru Surulere Surulere Tafa Tafawa Balewa Tai Takai Takum Talata Mafara Tambuwal Tangaza Tarauni Tarka Tarmuwa Taura Toungo Tofa Toro Toto Chafe Tsanyawa Tudun Wada Tureta Udenu Udi Udu Udung-Uko Ughelli North Ughelli South Ugwunagbo Uhunmwonde Ukanafun Ukum Ukwa East Ukwa West Ukwuani Umuahia North Umuahia South Umu Nneochi Ungogo Unuimo Uruan Urue-Offong/Oruko Ushongo Ussa Uvwie Uyo Uzo Uwani Vandeikya Wamako Wamba Warawa Warji Warri North Warri South Warri South West Wasagu/Danko Wase Wudil Wukari Wurno Wushishi Yabo Yagba East Yagba West Yakuur Yala Yamaltu/Deba Yankwashi Yauri Yenagoa Yola North Yola South Yorro Yunusari Yusufari Zaki Zango Zangon Kataf Zaria Zing Zurmi Zuru Next of Kin Next of Kin Phone Number Next of Kin Address Student Photo * Photo should not be less than 3 months Course * Choose Course Biomedical Engineering Computer Science Dental Surgery Assistant Dental Surgery Technician Dental Therapist Environmental Health Assistant Environmental Health Technician Fashion Designer Food Hygiene Footwear Technology Hair Stylist (Barbing) Health Education Health Information Technician HIV/AIDS HND in Health Information Management Human Nutrition and Dietary Occupational Health and Safety OND in Health Management Prosthetics and Orthotics Jamb Registration Number * Results * English Mathematics Physics Chemistry Biology Results1 English Mathematics Physics Chemistry Biology Results2 English Mathematics Physics Chemistry Biology Results3 English Mathematics Physics Chemistry Biology Results4 English Mathematics Physics Chemistry Biology Results5 English Mathematics Physics Chemistry Biology Grades * A1 B2 B3 C4 C5 C6 D7 E8 F9 Grades1 A1 B2 B3 C4 C5 C6 D7 E8 F9 Grades2 A1 B2 B3 C4 C5 C6 D7 E8 F9 Grades3 A1 B2 B3 C4 C5 C6 D7 E8 F9 Grades4 A1 B2 B3 C4 C5 C6 D7 E8 F9 Grades5 A1 B2 B3 C4 C5 C6 D7 E8 F9 Number of Sittings * 1 2
