AFFIX PASSPORT
PLEASE FILL IN DUPLICATE
PHOTOGRAPH
FEDERAL UNIVERSITY WUKARI (FUW)
Taraba State
APPLICATION FORM INTO FIRST DEGREE PROGRAMMES
2012/2013 SESSION: POST-UTME SCREENING EXERCISE
Form No.:
Seat No.:
Ref. No: FUW/REG./P-UTME/VOL.1/2012/13
PERSONAL DATA
Full Names (Surname First):
Sex:
Date of Birth:
E-Mail Address:
LGA.:
State of Origin:
GSM No:
Marital Status:
Maiden Names, if married
JAMB DATA
JAMB Registration Number:
JAMB Subjects/Scores
1………………………… 2.……………………………… 3……………………………….. 4. ………………………….
Total Score ……………..
CHOICE OF UNIVERSITY/COURSE
Candidates who chose FUW as 1st Choice
Course:
Candidates who chose FUW as 2nd Choice
Course:
Candidates Who did not Choose FUW as either 1st or 2nd Choice
Course:
SENIOR SECONDARY EXAMINATIONS DATA
1st Sitting Result
2nd Sitting Result
Examination Name:
Examination Name:
Examination No:
Examination No:
Examination Date:
Examination Date:
Subjects/ Grades
Subjects/ Grades
1…………………………
2…………………………………………….. 1………………………………… 2…………………………………
3……………………………… 4 ………………………………………..
3……………………………………4…………………………………
5……………………………… 6……………………………………..
5…………………………………… 6…………………………………
DECLARATION
I, ………………………………………………., shall accept as final the decision of the University with regard to my application. I also accept that
any information found to be false renders this application invalid.
Filled and submitted on:.......................
2012. FUW Admissions Office