DOMINEE COLLEGE
20 Benjamin Ayedun Street, Greenlands Estate, Agbodi, Aseese
opposite NASFAT Camp), Lagos Ibadan Express Way
Tel: +234(0)8164191241, (0)8033219140 Email:
[email protected]
PLEASE COMPLETE ALL SECTIONS OF THIS FORM IN BLOCK CAPITALS.
Candidate’s Details
Surname:
Proposed Start Date:
Forename(s):
School year at entry (please select):
Class
Preferred forename:
(if different from above)
Attendance Type:
Date of birth:
Day Student
Boarding Student
Language spoken at home:
Day/Month/Year e.g 24/03/1974
Gender :
Male
Female:
Nationality:
Religion:
Candidate’s address (see below for parent details):
Interests (eg music, drama, sports, reading):
Parents’ Details
FATHER
MOTHER
Title:
Title:
Surname:
Surname:
Forename:
Forename:
Does the father live at the same address as the
candidate?
YES
NO
Address (if different from candidate’s) Address
Does the mother live at the same address as the
candidate? YES
NO
(if different from candidate’s)
Tel (home):
Tel (home):
Tel (work):
Tel (work):
Mobile:
(please indicate which is the main contact number)
Mobile:
Email:
Email:
Occupation:
Occupation:
NB: You are required to inform us if any of the details given on this form subsequently change. It is our intention to
communicate by email as much as possible during the entry procedure, so please provide an email address which
will be checked regularly and advice us immediately of any changes. You will be asked to supply further
information nearer to the time of our assessment.
Parents living overseas will also be asked to nominate a guardian for their child before admission to the school.
Candidate’s Present School
Name of school:
Name of Principal/Head:
Address of school:
Tel:
Fax:
Email:
May we contact the principal or Head? YES
NO
This will not be done without your consent but must be done before the candidate attends or takes examinations.
Background Information
How did you find out about Dominee College
Family
Friends’
Agency
Other
Local knowledge
Current School
Website
Newspaper
Please give details:
Have you applied through an agency? Please give details:
(NB we are pleased to accept direct applications and it is not necessary to use an agency)
Publication
Does the candidate have a brother or sister who has attended or is applying to Dominee College? YES
Sibling name(s)
Sibling(s) date of birth
Day/Month/Year e.g 24/03/1974
Do you have a family connection with the school?
YES
NO
YES
NO
Has an application been made for a place in any other school in Nigeria? YES
If yes, please give details:
NO
If yes, please give details:
Have you visited the school (eg personal visit, open day)?
If yes, please give details:
Other applications:
Declaration
I / We request that the candidate be registered as a prospective pupil. I/We understand
that the standard terms and conditions of the school will undergo reasonable changes
from time to time as circumstances. Offers of places are subject to availability and the
relevant admission requirements of the school at the time.
Parent’s signature:
Parent’s name:
Date:
Day/Month/Year e.g 24/03/1974
20 Benjamin Ayedun Street, Greenlands Estate, Agbodi, Aseese
opposite NASFAT Camp), Lagos Ibadan Express Way
Tel: +234(0)8164191241, (0)8033219140 Email:
[email protected]
NO