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INTERNATIONAL REGISTRATION ADMISSION FORM

SECTION ONE – PERSONAL DETAILS

- Title
  
  MrMrsMiss
- Others
- First Name *
- Other Names
- Surname *
- Date of Birth
- Birth Certificate Please upload a copy of your birth certificate
- Gender *
  
  MaleFemale
- Country of Citizenship *
- Ethnicity *

SECTION TWO – CONTACT DETAILS

Current Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

How can we contact you?

Home Phone *
Mobile Phone *
Work
Email *

Emergency Contact

- Name
- Relationship to you?
- Phone

SECTION THREE – PROGRAMME SELECTION

- Programme 1
- Programme 1

SECTION FOUR – ENGLISH PROFICIENCY

What is your first language?

Have you ever had your enlish abilities or proficiency tested?

- YesNo
- Date of Assessment

SECTION FIVE – SECONDARY SCHOOL STUDIES

please provide verified official documentation of academic results for all qualifications
Name of School
Highest qualification

Year

- Year Started
- Year Finished
- Successfully completed
  
  YesNo
- Upload Results

SECTION SIX – TERTIARY SCHOOL STUDIES

please provide verified official documentation of academic results for all qualifications
Name of School
Highest qualification

Year

- Year Started
- Year Finished
- Successfully Completed
  
  YesNo
- Upload Results
- What is the highest tertiary qualification you hold? (please tick one)
  
  Vocational qualification (trade)CertificateDiplomaGraduate certificate/diplomaBachelors degreePostgraduate qualificationPostgraduate qualificationMasters
- Others
- Please upload a verified translation of your results.

SECTION SEVEN – STATISTICAL INFORMATION

- How did you hear about Academic Temple Educational Consult? please tick one
  
  Embassy/trade and enterpriseFriendsEducation fair/expoOther Education providerAgentFamily memberAdvertisementHigh schoolInternetOthers

SECTION EIGHT – IMPAIRMENTS

- do you live with the effects of a significant injury, long-term illness, or disability?
  
  YesNo
- if yes, please indicate by ticking the appropriate box below
  
  DeafImpairment Blindspecific learning disabilityHead injurymobility/physicalHearingVision impairmentmedicalmental healthspeech impairment
- Others Please specify

SECTION NINE – IMPORTANT DOCUMENTS

- Please upload a the following documents
- Passport Photograph
- International Passport
- Acount Statements (6 months – 1year)

SECTION TEN – FAMILY INFORMATION

Father’s Information

DeceasedUnknown
Family Name(s)
Given Name(s) First:
Given Name(s) Middle
Address

Same as applicant:
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Email
Occupation
Employer
Mother’s Information

DeceasedUnknown
Family Name
Given Name(s) First
Given Name(s) Middle
Address

Same as applicant
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Occupation
Employer

Verification

Logged in as Director. Verification not required.
Please enter any two digits *Example: 12
This box is for spam protection – please leave it blank:

5, Elmes Road off Edmund Crescent
Yaba,Lagos State.

[email protected]

0812 227 9157
0805 539 2491
0803 865 0982

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Copyright © 2020 Academic Temple Educational Consult,

All Rights Reserved.

5, Elmes Road off Edmund Crescent
Yaba,Lagos State.

[email protected]

0812 227 9157
0805 539 2491
0803 865 0982

Follow

Copyright © 2020 Academic Temple Educational Consult,

All Rights Reserved.

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