James U. Okwandu Memorial Technical College
Skills Acquisition and Vocational Training Center
Umuogbala, Onicha-Ngwa, Onicha-Ngwa Amairinano Autonomous Community, Obingwa L.G. A. Abia State, Nigeria
Phone: 08129549178 or 00917904902179
Email: o.o.okwandu@gmail.com
STUDENT APPLICATION FORM
Date: ____________________ Receipt Number ________________
Applying for admission into class ____________ Admission Form No. ___________________
1. Name of student ___________________________________________________________
Last Name                      First Name                          Middle Name
2. Date of Birth _______________ Age _______________ Sex ______________
3. Place of Birth _______________ Home Town/Village _________________________
4. L.G.A. _____________________ State _____________________________________
5. Contact Address _______________________________________________________
6. Father’s Name ________________________________ GSM No. ________________
7. Mother’s Name _______________________________ GSM No. ________________
8. Name of Guardian (where applicable) ___________________ GSM No. __________
9. Name of person responsible for applicant’s fees in school: _____________________
(i) Place of Employment: ____________________________________________
(ii) Address (if not parent) ____________________________________________
10. Parent/Guardian’s relationship to J.U.O.M.T.C. (employee, contractor, BOG member, other- explain) ________________________________________________________
11. Parent/Guardian’s email address __________________________________________
12. Contact person in case of emergency ____________ (father, mother, etc.) by phone.
13. Emergency GSM or other phone number ___________________________________
14. Previous school attended/presently attending _______________________________
15. Final class attended in previous school _____________________________________
16. Name of Administrator of previous school __________________________________
17. Academic qualification: (evidence to be provided) ____________________________
(i) FSLC Exam. Year obtained _________________________________________
(ii) FSLC Exam. Candidate for 2016/2017 academic year Yes__ NO__
18. Have you ever been expelled, or suspended from any school? Yes__ NO__
(i) If Yes, please give reason __________________________________________
19. Religious affiliation ________________________ church
(i) If Christianity, what denomination? _________________________________
(ii) If Seventh-day Adventist, what is your local church name? _______________
____________________ District name? _____________________________
Declaration:
I, ______________________________, hereby declare that as a student of J.U. Okwandu Memorial Technical College, I shall respect the authorities of the institution, abide by the rules and regulation of the school, failure of which I shall be subjected to the administration of the school’s rule disciplinary action.
Signature of the applicant ______________________________ Date _____________