form – LEVITES CHRISTIAN UNIVERSITY

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APPLICATION FORM

UPLOAD PASSPORT*

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UPLOAD TELLER*

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TITLE

SURNAME*

MIDDLE NAME*

LAST NAME*

DATE OF BIRTH*

COUNTRY OF BIRTH*

NATIONALITY*

HOME ADDRESS*

TELEPHONE NO.*

E-MAIL ADDRESS*

PROPOSED PROGRAM OF STUDY*

EDUCATIONAL QUALIFICATIONS

PRIMARY SCHOOL ATTENDED*

FROM*

TO*

SECONDARY SCHOOL ATTENDED*

OTHER INSTITUTION ATTENDED*

WAEC/GCE/ NECO RESULTS AND GRADES
1ST SITTING

SUBJECT 1*

GRADE*

SUBJECT 2*

GRADE*

SUBJECT 3*

GRADE*

SUBJECT 4*

GRADE*

SUBJECT 5*

GRADE*

SUBJECT 6*

GRADE*

SUBJECT 7

GRADE

SUBJECT 8

GRADE

SUBJECT 9

GRADE

2ND SITTING (IF ANY)

PERSONAL INFORMATION

NAME OF PARENTS/GUARDIAN

CHRISTIAN IDENTITY

PHONE NO OF PARENTS/ GUARDIAN

E-MAIL ADDRESS OF PARENTS/GUARDIAN

MARITAL STATUS*

NAME OF SPOUSE

PHONE NO OF SPOUSE

NAME OF CHILD/CHILDREN

ARE YOU EMPLOYED*

OCCUPATION

POSTAL ADDRESS

OTHERS

PROPOSED SOURCE OF FINANCE*

ARE YOU CURRENTLY RUNNING ANY PROGRAM AT ANY NIGERIAN UNIVERSITY?

HAVE YOU APPLIED FOR ANY OF LCU NIGERIA PROGRAM BEFORE? IF SO GIVE PROGRAM AND WHICH YEAR

PLEASE STATE ANY PHYSICAL OR OTHER DISABILITIES WHICH MAY NECESSITATE SPECIAL ARRANGEMENTS OR FACILITIES

FROM WHAT SOURCE DID YOUU LEARN OF THIS OPPORTUNITY (IF BY ADVERT PLEASE SPECIFY WHICH PUBLICATION)

I certify that I have completed this application form myself and that all the information provided are correct and up-to date as at the time of completing this form.*

AGREE