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15 views2 pages

Add Form

Uploaded by

academicsadvancer
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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QUEEN OF THE ROSARY

COMPREHENSIVE
SECONDARY SCHOOL,
EZIOWELLE P.O.BOX 5
Phone: 09070022377
email:[email protected]
FORM NO:................................ ADMISSION FORM

1.
Surname:................................................................................................................
..................................................
2. Other Names:
3. Date of birth: Month: Year: Sex:
4. Town &
Village:....................................................................................................................
................................
5. Local Government
Area:.......................................................................................................................
.........
6. State of
origin:......................................................................................................................
.............................
7. School(s)
attended:................................................................................................................
...........................
8. Last class passed &
year:........................................................................................................................
.......
9. Certificate passed &
year:........................................................................................................................
......
10. Any post
held:........................................................................................................................
...........................
11. Denomination: catholic, Anglican, specify if any other

.........................................................................................................................
.....................................................
12. Have you any disability, allergy, chronic disease, mental challenge specify
any......................
.........................................................................................................................
....................................................
13. Father’s
name:......................................................................................................................
............................
14. Address and phone
number:..................................................................................................................
.....
15. Mother’s
name:......................................................................................................................
............................
16. Address and phone
number:..................................................................................................................
......
17. Sponsor’s
name:......................................................................................................................
..........................
18. Address and phone number of
sponsor:.................................................................................................
19. Relationship with
sponsor:..................................................................................................................
..........
20. Date:........................................................Applicant’s
signature:....................................................................

INSTRUCTION
1. This application must be completed by all applicants with two passport
photograph and a
Photocopy of the baptismal card.
2. The form is to be obtained with an application fee of N500
3. Entrance examination will take place in the school hall
on....................................Time 9.00am
4. Pay a non-refundable fee of N200 for the interview.

DECLARATION
I................................hereby declare that the particulars given in this form are
correct and if admitted,
I shall regard myself bound by the rules and regulations of the school.

FOR OFFICE USE ONLY


Form issued
by:.....................................................................................Date:.............................
...............................
Completed form Received
by:...........................................................................................................................
.....
Decision Accepted/Not
Accepted:................................................................................................................
.......
Date of
Registration:............................................................................................................
......................................
Admission
Numbers:................................................................................................................
..................................

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