Official Registration Portal for IJMBE, JUPEB, and other professional examinations

APPLICATION FORM

Ensure that every information supplied is valid and correct; Misinformation shall invalidate your admission.
Section A: Personal Data
Full Name

SurnameYour NameOther Name
Gender

MaleFemale
Date of Birth

DayMonthYear
Disabilities
(Blind/Deaf/Physical Handicap):
Marital Status
(Single/Married/Divorced):
State of Origin
Local Government Area.
Postal Address

Residential Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
Phone Number*
Parent/Guardian Details
Name*

TitleFirst NameLast Name
Relationship
Email (if any)
example@gmail.com
Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Next of Kin Details
Name*

TitleFirst NameLast Name
Relationship
Email (if any)
example@gmail.com
Phone Number*
Section B: Entry Qualification
No. of Sittings
1st sitting Exam Type
Exam Year
Examination Number
2nd sitting Exam Type
Exam Year
Examination Number

O LEVEL RESULT

Section C: Aspired University and Course
Discipline
First Choice Institution
First choice course
Second Choice Institution
Second choice course
Section D: Choice of Programme
Programme in View*
Most Preferred Study Center
Preferred Study Center
Would you like our hostel accommodation?*
When would you resume for lectures?

DayMonthYear
Declaration*

I hereby declare that all information given in this form is to the best of my knowledge and correct. Any false information given in this form will automatically disqualify me from being considered for admission and that i will comply with the rules and regulations of the school.
Should be Empty:

APPLICATION FORM