DPO Application Form
DPO Application Form
YEAR
SECTION 1
1. PERSONAL DATA
1.1 SURNAME:
1.3 FORENAMES:
(As on birth certificate)
1.10 DATE OF BIRTH: e.g. Day (15) Month (04) Year (2008) ………………………………………………………………
1.12 DO YOU SUFFER FROM ANY PHYSICAL OR OTHER DISABILITIES FOR WHICH ARRANGEMENTS AT
INSTITUTE WOULD BE NECESSARY? YES (Y), NO (N)
2. ADDRESS (PERMANENT)
1
3. TELEPHONE NUMBERS
4. NEXT OF KIN
SECTION 2
5. ENTRY REQUIREMENTS
Normal Entry –
Special Entry –
International Entry –
Indicate the type of entry (admission) preferred with a tick in the relevant box below.
Normal Entry
Special Entry
International Entry
9. UNIVERSITY ATTENDED
Have you ever attended any other universities? Yes (Y) / No (N) If yes: Name
and Address of University attended
………………………………………………………………………………………………………………………….
…………………………………………………………………………..……………………………………………..
PROGRAMME OF STUDY……………………………………………………………………………………………
……………………………………………………………………………………………….………………………….
……………………………………………………………………………………………….…………………………
12.1 Applicants must complete all sections of the application form carefully and legibly. If the Institute discovers that any
information submitted by the applicant is false, the Institute will reject that application and may refer the matter for legal
action.
3
12.2 Applicants must endorse at the bottom of this page that they have understood the notes given below and that they agree to
their application being considered under the conditions outlined below.
12.3 Applicants MUST submit with this form, photocopies (not originals) of all qualifications/certificates referred to in the
application, including birth certificates. The copies of the certificates must be verified by a Commissioner of Oaths or
Head/Principal of the Institute at which the examinations were taken.
12.4 Finance
12.4.1 Applicants must ensure that they have the necessary finance to pay on registration. It is the student’s responsibility
to secure sponsorship, if this is needed.
13. I DECLARE THAT THE INFORMATION I HAVE GIVEN IS CORRECT, AND THAT SHOULD IT BE FOUND TO BE
FALSE MY APPLICATION WILL BE DISQUALIFIED AND I WILL FACE POSSIBLE LEGAL ACTION.
N.B: BEFORE YOU SIGN AND DATE THIS FORM, PLEASE CHECK THAT YOU HAVE COMPLETED EACH RELEVANT
SECTION AND THAT THE INFORMATION IS CORRECT.
The completed form should be accompanied with certified copies of the following:
SECTION 3
CERTIFICATES RECEIVED/VERIFIED
App No.
Normal
Special