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Is Your Mother Alive?
Is Your Father Alive?
Father/Guardian's Name, Address and Occupation
State of Origin
Place of Birth
Select Marital Status
Number of Children
NAME AND ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY. (state your relationship with this person)
Phone Number of Emergency Contact
Next of Kin Details
Name of Next of Kin
Address Next of Kin
Phone Number of Next of Kin
Relationship with Next of Kin
Name of First Referee
Address of First Referee
Name of Second Referee
Address of Second Referee
Name of Third Referee
Address of Third Referee
Do You Have up to Five (5) Credits?
Do You Have Credit in English Language?
Which Science Subjects did you get credit in?
Are you currently registered for any course in this institution?
If currently enrolled in any course, specify course and school
Date the offer was made
Prizes and Special Distinctions
Title of Published Works
Other Languages You Can Speak and Your Fluency Level
List Physical Disabilities if Any
Do You Have Normal Sight?
Application Details-(WHAT DEGREE, DIPLOMA OR CERTIFICATE OF THIS INSTITUTION DO YOU WISH TO BE CONSIDERED FOR? Indicate the details below)
Subject/Field of Study
Special topic within the subject
Study Mode - (Full-time or Part-time?)
If part-time, how can you adjust the demands of your present employment with those of your study?
By checking the box below, I hereby declare that particulars which I have supplied above are true to the best of my knowledge and belief. I am aware that withholding any information or/and giving false information automatically disqualifies me from gaining admission, if admitted to the School of Nursing, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, I shall regard myself bound by the statutes, Ordinances and Regulations of the Hospital in so far as they affect me.