1. law, govt and politics
2. government
3. embassies and consulates

CAPE COAST POLYTECHNIC
APPLICATION FOR ADMISSION
INTO BACHELOR OF TECHNOLOGY PROGRAMMES
Affix
Passport
Picture
Applicants are requested to send two (2) completed forms to the Office of the Registrar to reach him
not later than……………………………………………………….. with:
a)
b)
c)
d)
Four (4) recent passport-size photographs.
Endorse on the reverse side of (1) copy.
Write at the back of the remaining 3 copies your name and programme applied for:
Affix one copy to each Application Form.
Any applicant who provides false information on the Form will be refused admission, or if he/she has already been
admitted will be withdrawn from the Polytechnic.
(PLEASE COMPLETE IN BLOCK LETTERS)
1. Programme Applied for:…………………………………………………………………………………
2. Personal Details of Applicants:
i. Surname: Mr./Mrs./Ms……………………………………………………………………………
ii. Other name(s)……………………………………………………………………………………...
(In full, not abbreviated and in the same order as on your certificates)
iii. Permanent Postal Address:………………………………………………………………………..
………………………………………Email Address (if any)…………………………….............
iv. Date of Birth:……………………………………………………………………………………...
v. Nationality:……………………………………………………………………………………….
vi. Place of Birth:……………………………………..District:…………………………………….
vii. Home Town:……………………………...................Region/District:…………………………..
viii. Telephone number:………………………………………………………………………………
3.
Particulars of Parent/Guardian:
i. Parent’s/Guardian’s Name:………………………………………………………………………
Relationship:……………………………………………………………………………………..
ii. Address of parent/Guardian:……………………………………………………………………..
……………………………………………………………………………………………………
iii. Parent’s/Guardian’s occupation:…………………………………………………………………
4. Educational Qualifications
Give details of Academic and Professional qualifications already obtained
Name of Institution
Address
Date (Month/Year)
Of Attendance
From
To
Qualifications/Awards
(Including Class and Division)
NB. Certified photocopies of all diplomas, certificates and courses transcripts awarded for these
qualifications must be enclosed with this Application Form.
1
5. Provide the address of two referees, one of whom must be former lecturer/project supervisor
i. Name:………………………………………………………………………………………………………
Address:……………………………………………………………………………………………………
ii.
Name:………………………………………………………………………………………………………
Address:……………………………………………………………………………………………………
6. Employment History
Name of Organization
……………………………….....
…………………………………
………………………………….
………………………………….
Position Held
Date
....................................................
………………………………….
…………………………………
…………………………………
……………………………….
………………………………..
………………………………..
………………………………..
7. Bond
i. Are you bonded?
Yes/ No
ii. If bonded, indicate name of organization you are bonded to………………………….............................
……………………………………………………………………………………………………………
and date when your bonds expires………………………………………………………20…………….
8. Financial Support
Source of financing your programme of study, Tick appropriate area(s)
(i)
SSNIT Student Loan Scheme
(ii)
Study Leave with pay
(iii)
Self Financing
(iv)
Other(s) not indicated above (specify)
NB. The Polytechnic does not give financial assistance to students accepted for its programmes
9. Endorsements
(a) Declaration and signature of Applicant
I declare that that the information provided is correct. I understand that any offer of admission may be
withdrawn if the information provided is fraudulent or if I cannot provide documentary evidence.
…………………………………….
Signature of Applicant
…………………………………….
Date
(b) Endorsement by Referee
This form must be endorsed by someone of high repute who must read and sign the following declaration.
I certify that the applicant is personally known to me, and that I have vetted both the photograph attached,
and the claims contained in this application and that to the best of my knowledge, the information can be
said to be true.
Name:…………………………………………………………………………………………………………
Signature:………………………………………….............Date:……………………………………………
Address:………………………………………………………………………………………………………
………………………………………………………………………………………………………………
10. Official use only.
Finance office use only
Receipt Number
Date
Application fee
Completed Application Forms should be returned to
The Registrar
Cape Coast Polytechnic
P. O. Box AD 50
Cape Coast.
2