Application Form
STUDENT BIODATA
NOTE: The Fields mark * are Required
Title*
Surname*
First Name*
Other Name
Sex*
Permanent Home Address*
Phone Number*
Personal Information
Date Of Birth
DD/MM/YYYY		*
Place Of Birth
State Of Origin*
L.G.A*
Marital Status*
Maiden Name
Sponsor Details
Sponsor's Name*
Sponsor's Email address
Sponsor's Occupation*
Sponsor's address*
Sponsor's Phone number*
Email Address
Email Address
Secondary School Attended With Dates
School Name From (YYYY) To (YYYY)
*1
2

O Level Exam Result
Examination Name*
Examination Date
DD/MM/YYYY		*
Examination Number*
Examination Center*
Exam Result, Specify your result in the form A1, B3, C6, E8
Subject Grade Subject Grade
1 2
3 4
5 6
7 8
9 10

SECOND SITTING O LEVEL EXAMINATION
Examination Name
Examination Date
DD/MM/YYYY
Examination Number
Examination Center
Exam Result, Specify your result in the form A1, B3, C6, E8
Subject Grade Subject Grade
1 2
3 4
5 6
7 8
9 10

Programme * Tick as desirable
IJMB     
Subject Combination*
Department for studies*
Proposed Course of Study*
declaration*
I hereby declare that information given above is true and that I shall abide by all the rules and regulation governing the I.J.M.B Examination.
Agree     Reject