Carefully fill the form with the correct details (*) items are cumpulsorySection A - PERSONAL INFORMATIONPassport Photograph* (Max file size: 500kb) (File type: jpg,jpeg,png.)Name* First Middle Surname Other Name(s) Other names that may appear on your academic records (please attach evidence of change of name)Sex* Male Female Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Marital Status* Single Married Widowed Other Permanent Address* State of Origin*AbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEnuguEdoEkitiGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfaraLocal Government Area* Email* E-mail is a primary means of communication with applicants. WESTLAND POLYTECHNIC Admission office will send important messages to you using the email address that you input on this application page. It is your responsibility to check this e-mail account regularly and read your messages from Westland. Be sure to notify the college if this email address changes .Phone*Proposed Course (Department)* Accountancy Business Administration Computer Engineering Computer Science Electrical Electronics Mass Communication Science Laboratory Technology SECTION B- ACADEMIC QUALIFICATION WITH DATESQualification* Start Year*20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970End Year*20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970Qualification* Start Year*20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970End Year*20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970Qualification Start Year202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970End Year202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970SECTION C: O-LEVEL RESULTYear*20222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970Exam Type* WAEC GCE NECO NABTEB Awaiting Result* Yes No Subject*English LanguageMathematicsBiologyGrades*A1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject*English LanguageMathematicsBiologyGrades*A1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject*English LanguageMathematicsBiologyGrades*A1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject* Grades*A1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject* Grades*A1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradesA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradesA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradesA1A2A3B1B2B3C4C5C6D7P7E8P8F9Second SittingInput your second sitting result if you are using a combined resultSubjectEnglish LanguageMathematicsBiologyGradesA1A2A3B1B2B3C4C5C6D7P7E8P8F9SubjectEnglish LanguageMathematicsBiologyGradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9SubjectEnglish LanguageMathematicsBiologyGradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9Subject GradeA1A2A3B1B2B3C4C5C6D7P7E8P8F9SECTION D - EMPLOYMENT STATUSEmployment Status* Employed Unemployed SECTION E - SPONSORSponsor* Self Government NGO Parent Guardian CERTIFICATIONDo you certify that all information provided above are accurate?* Yes You certify under the perjury under the laws of Osun State that you have provided complete and accurate responses to all the items on this application. You further certify that all official documents submitted in support of this application are authentic and unaltered records that pertain to me. You understand that any misrepresentation or omission may be cause for denial or cancellation of admission or enrollment. Form Fee* Price: ₦ 8,500.00 Quantity:
