Buden Waje School of Health, Science and Technology

Student Application Form

Please complete all required fields. Progress is saved locally while filling.

Student Bio-Data

Passport Photo (max 1000 KB) *

Drag & drop an image here

or click to select a file

Maximum size: 1000KB (1MB)

Please upload a clear passport photo. Max size 1000 KB.

First Name *

Middle Name *

Last Name *

Date of Birth *

Gender *

Active Email Address *

Phone Number *

Home Address *

Applicant NIN *

Disability (If Any)

Marital Status *

Course Applying To

First Choice *

Second Choice *

Institutions Attended

O'Level/SSCE Certificate Obtained

First Sitting

Exam Type *

Exam Year *

Exam Number *

Subject	Grade

Second Sitting (optional)

Exam Type

Exam Year

Exam Number

Subject	Grade

JAMB (optional)

JAMB Number

JAMB Year

Subject	Score

Total Score

Parent/Guardian Information

Parent/Guardian Name *

Parent/Guardian Phone *

Parent/Guardian Address *

Parent/Guardian Email *

Attestation

I hereby declare that the information stated above is accurate. If any information is found to be false, I shall be liable to legal action which will subsequently lead to expulsion from the programme, and no amount of fees shall be refunded.

Signature *

Date *