Attach 2 Passport Photographs Here Application Form 2015/2016 Session AL-AZHAR INTERNATIONAL COLLEGE and Montessori Nursery / Primary School Zango Daji P O Box 379 LOKOJA, NIGERIA http://www.al-azharinternationalcollege.com Application for Admission for 2015/2016 session into: i. ii. iii. iv. v. Montessori Nursery Classes Primary 1, 2, 3, 4 & 5 JSS 1, 2 & 3 SSS 1 & 2 Tahfeezul Quran TICK CLASS INTO WHICH ADMISSION IS BEING SOUGHT Montessori NURSERY / PRIMARY 1 SECONDARY & Tahfeezul Quran Sch Montessori NURSERY 2 PRIMARY ONE 3 PRIMARY TWO 4 PRIMARY THREE 5 PRIMARY FOUR 6 PRIMARY FIVE 1 JSS ONE 2 JSS TWO 3 JSS THREE 4 SSS ONE 5 SSS TWO 6 Tahfeezul Quran Student’s Name ........................................................................................................................ Surname First Name Middle Name Date of Birth (DD/MM/YYYY) ........./......../........... Age as at 1st September 2015: [ ] yrs Sex: Male [ ] Female [ ] Present Class........................................ Blood Group...................Nature of ill health (IF ANY).............................................................. e-mail Address...................................................................................................................... Name of Present School........................................................................................................ Present School Address............................................................................................................................................. State of Origin ................................ L G A ................................Nationality........................................ Town of Residence.............................................................................................................................. Father's / Guardian’s Full Name (Surname First) .............................................................................. Father's / Guardian’s Occupation .............................................................................................. Father’s / Guardian’s GSM Phone Number ....................................................................................... Father’s / Guardian’s e-mail Address .................................................................................................... Mother's Full Name ................................................................................................................................ Mother's Occupation ............................................................................................................................... Parent's / Guardian’s Postal Address ................................................................................................... .............................................................................................................................................................. Residential Address (if different from the above)................................................................................................................................................... ............................................................................................................................................................... Preferred Examination Centre (LOKOJA, ABUJA, or LAGOS) ................................................................ Parent's / Guardian’s Signature..........................................Date....................................... Student’s signature................................ Date..................................... SUBMISSION OF APPLICATION Pay application fee (N5,000 for Secondary or N3,000 for Montessori Nursery/Primary & N2,000 for Tahfeezul Quran) into Al-Azhar Int’l College Account at: First Bank, Account No: 2015019642 OR Fidelity Bank, Account No: 4010594246 Submit completed form and admission application form fee payment evidence at the school complex OR by surface post to: P O Box 379, Lokoja, Kogi State Nigeria OR scan the completed form and payment evidence and e-mail to: [email protected]