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This document is a Mature Entrance Application Form for Pentecost University, requiring personal information, educational background, and examination details from applicants. It includes sections for student information, employment details, and financial sponsorship, as well as a declaration statement. Applicants must submit the form with supporting documents, including certified copies of results and photographs.

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8 views4 pages

View File

This document is a Mature Entrance Application Form for Pentecost University, requiring personal information, educational background, and examination details from applicants. It includes sections for student information, employment details, and financial sponsorship, as well as a declaration statement. Applicants must submit the form with supporting documents, including certified copies of results and photographs.

Uploaded by

bamoako
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PENTECOST UNIVERSITY

Affix with glue


one of the two
endorsed
MATURE ENTRANCE APPLICATION FORM photographs here
and clip the other
on the form

FORM NO: PROGRAMME APPLIED FOR

(Please tick where appropriate)


MORNING EVENING WEEKEND
LEVEL APPLIED FOR LEVEL 100 LEVEL 200 SCHOOL (M/S) SCHOOL (E/S) SCHOOL (W/S)

STUDENT INFORMATION

NAME (In Capitals) SURNAME TITLE MR. MRS. MS. DR. REV.

FIRST NAME OTHER NAME(S)

Names must correspond exactly with those used for all examinations taken. Provide legal proof of any change in name

DATE OF BIRTH PLACE OF BIRTH GENDER FEMALE MALE

D D M M Y Y Y Y

NATIONALITY HOME TOWN

REGION OF HOME TOWN RELIGION

MARITAL STATUS SINGLE MARRIED DIVORCED

ADDRESS TO WHICH COMMUNICATION IN CONNECTION WITH THIS APPLICATION SHOULD BE SENT

TELEPHONE NO. E­MAIL ADDRESS

PERMANENT HOME ADDRESS (IF DIFFERENT FROM ABOVE)

TELEPHONE NO.

NAME OF PARENT/GUARDIAN/SPONSOR

OCCUPATION OF PARENT/GUARDIAN/SPONSOR TELEPHONE NO.

ARE YOU PHYSICALLY CHALLENGED OR DO YOU SUFFER ANY FORM OF CHALLENGE? YES NO

IF YES PLEASE SPECIFY

ARE YOU CURRENTLY IN EMPLOYMENT? YES NO IF YES:

INDICATE TYPE/NATURE OF EMPLOYMENT

NAME AND ADDRESS OF EMPLOYER


EDUCATIONAL BACKGROUND

SCHOOLS ATTENDED WITH DATES

NAME OF SCHOOL DATES ATTENDED QUALIFICATIONS OBTAINED

1)

2)

3)

EMPLOYMENT DETAILS

DATE OF
DATE OF
NAME OF COMPANY EMPLOYMENT POSITION HELD DUTIES
EMPLOYMENT
ENDED

EXAMINATION DETAILS

SSSCE / WASSCE 1ST SITTING 2ND SITTING 3RD SITTING

INDEX NUMBER

YEAR

MONTH

CORE ENGLISH

CORE MATHEMATICS

CORE / INTEGRATED SCIENCE

CORE SOCIAL STUDIES

ELECTIVE

ELECTIVE

ELECTIVE

ELECTIVE

ELECTIVE
G.C.E. “O” LEVEL / “A” LEVEL 1ST SITTING 2ND SITTING 3RD SITTING

INDEX NUMBER G.C.E. “O” LEVEL G.C.E. “A” LEVEL G.C.E. “O” LEVEL G.C.E. “A” LEVEL G.C.E. “O” LEVEL G.C.E. “A” LEVEL

YEAR

MONTH

ENGLISH LANGUAGE

MODERN MATHS

OTHER SUBJECTS:

OTHER(S) SPECIFY EXAM/EXAMINATION BODY 1ST SITTING 2ND SITTING 3RD SITTING

INDEX NUMBER

YEAR

MONTH

GENERAL PAPER

REFERENCE

COMMENT ON
PERIOD YOU
CANDIDATE’S
NAME POSITION HAVE KNOWN
ABILITY TO PURSUE
THIS APPLICANT
THIS PROGRAMME
PROGRAMME SPONSORSHIP

TICK THE APPROPRIATE BOX TO INDICATE HOW YOU WOULD FINANCE YOUR STUDY AT THE UNIVERSITY

Please provide name and


SELF contact details of your sponsor:

PARENT/GUARDIAN

EMPLOYER

OTHER (PLEASE SPECIFY)

DECLARATION

I.........................................................................................................................................................................................DECLARE THAT

ALL THE PARTICULARS FURNISHED BY ME ON THIS APPLICATION FORM ARE GENUINE AND REFLECT MY TRUE RECORDS

DATE SIGNATURE

NOTE

AN APPLICANT WHO MAKES A FALSE DECLARATION OR WITHOLDS RELEVANT INFORMATION MAY BE REFUSED ADMISSION.
IF HE//SHE HAS ALREADY ENROLLD IN THE UNIVERSITY, HE/SHE WOULD BE ASKED TO WITHDRAW

NOTE

Candidates are required to send completed forms with the following enclosurers to:
The ABE Co­ordinate, Pentecost University, P. O. Box KN 1739, Kaneshie ­ Accra

1. CERTIFIED PHOTOCOPIES OF RESULT SLIPS OR CERTIFICATES

1. ONE SELF­ADDRESSED EMS/FEDEX ENVELOPE

3. TWO RECENT PASSPORT­SIZE PHOTOGRAPHS (ONE OF THE PHOTOGRAPHS SHOULD BE ENDORSED BY A MINISTER OF RELIGION, A SENIOR

PUBLIC SERVANT OR A LEGAL PRACTITIONER)

FOR OFFICE USE ONLY

NAME SIGNATURE

AMOUNT GH¢ DATE

P. O. BOX KN 1739, KANESHIE, ACCRA, GHANA­W.A TEL: 233­302­417057/8; EMAIL: [email protected]

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