admission | College of health Sciences, management and technology

SECTION A: PERSONAL INFORMATION

Application Number:

Surname:

First Name:

Middle Name:

Date of Birth:

Gender:

Male Female

Marital Status:

Nationality:

State of Origin:

Local Government Area:

Religion:

National Identification Number (NIN):

Phone Number:

Alternative Phone Number:

Email Address:

Residential Address:

Passport Photograph: Attach a recent passport photograph.

SECTION B: PROGRAMME INFORMATION

CATEGORY OF ADMISSION

National Diploma (ND) Programme Degree Programme

NATIONAL DIPLOMA (ND) PROGRAMMES

School of Health Sciences

Public Health Community Health Extension Worker (CHEW) Pharmacy Technician Medical Laboratory Technician (MLT) Paramedics Health Information Management Environmental Health Technology

DEGREE PROGRAMMES

Faculty of Science and Computing

Computer Science Cyber Security Software Engineering Biotechnology Industrial Chemistry Physics with Electronics

Faculty of Health Sciences

Public Health Nursing Science Medical Laboratory Science

Faculty of Management Sciences

Accounting Economics and Development Studies Business Administration Entrepreneurship Taxation Human Resource Management Mass Communication

ADMISSION REQUIREMENTS (ATTACH THE FOLLOWING DOCUMENTS)

SECTION C: ACADADEMIC RECORDS

Secondary School Attended

Name of School:

Year of Graduation:

O'Level Qualification

Examination Body:

WAEC NECO NABTEB GCE

Examination Number:

Year of Examination:

Number of Credits Obtained:

SECTION D: PARENT/GUARDIAN INFORMATION

Father's Information

Full Name:

Occupation:

Phone Number:

Address:

Mother's Information

Full Name:

Occupation:

Phone Number:

Address:

Guardian Information (Where Applicable)

Guardian's Name:

Relationship:

Phone Number:

Email Address:

Occupation:

Address:

SECTION E: HEALTH INFORMATION

Do you have any medical condition that may require special attention?

Yes No

If Yes, please specify:

SECTION F: DOCUMENT CHECKLIST

Please attach photocopies/scanned copies of the following documents:

WAEC/NECO/NABTEB Result

Birth Certificate or Age Declaration

National Identification Number (NIN) Slip

JAMB Result Slip (where applicable)

JAMB Change of Institution Slip (where applicable)

Testimonial from Previous School

Local Government Identification Letter

CROWN POINT COLLEGE OF HEALTH SCIENCES MANAGEMENT AND TECHNOLOGY

IN AFFILIATION WITH HAVILLA UNIVERSITY, NDE-IKOM, CROSS RIVER STATE

ADMISSION APPLICATION FORM

INSTRUCTIONS TO APPLICANTS

APPLICATION FEE PAYMENT DETAILS

SECTION A: PERSONAL INFORMATION

SECTION B: PROGRAMME INFORMATION

CATEGORY OF ADMISSION

NATIONAL DIPLOMA (ND) PROGRAMMES

DEGREE PROGRAMMES

ADMISSION REQUIREMENTS (ATTACH THE FOLLOWING DOCUMENTS)

SECTION C: ACADADEMIC RECORDS

Secondary School Attended

O'Level Qualification

SECTION D: PARENT/GUARDIAN INFORMATION

Father's Information

Mother's Information

Guardian Information (Where Applicable)

SECTION E: HEALTH INFORMATION

SECTION F: DOCUMENT CHECKLIST