Pre-Registration Form

Form
Pre-Registration form

Please fill this simple for with correct details.
Name*

First NameMiddle NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Gender*
Select your gender
Date of Birth*

DayMonthYear
Date
State of Origin*
Local Government*
State of Residence*
Parent/Guardian Name*
Guardian Relationship*
Guardian Phone Number*

Area CodePhone Number
Program of choice*

JUPEBIJMBCBT Training OnlyUTME/CBTUTME TutorialsLevel tutorial
Would You Prefer Our Hostel Facility*
NIN*
Please provide your NIN number for verification purposes
NIN Image*

Provide a clear image of your NIN ID
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Passport Photograph*

Provide a clear image of your Passport Photograph
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Should be Empty: