Maxie Hostel Application Form

Application Form

Maxie Hostel, Kotei - Kumasi (GH)
Full Name*

First NameMiddle NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Gender*

MaleFemale
Nationality
Field of Study / Department*
Current Year / Level*

Level 100Level 200Level 300Level 400
Guardian / Emergency Contact Person*

First NameMiddle NameLast Name
Emergency Contact Number*

Area CodePhone Number
Room Number
Move-in Date

DayMonthYear
Have you ever been evicted from a hostel?*

YesNo
Do you smoke?*

YesNo
Identification Card*

Cancelof
Appliance Checklist*
By submitting this application you agree:

1) The information provided herein is complete and accurate. Providing incomplete and/or false information could result in the rejection of the application.

2) Additional information may be required in order to process your application. The administrative may contact you to request for any additional information necessary to complete application process.
Confirm

I Agree
Signature

Clear
Should be Empty: