NATIONAL TEACHERS' INSTITUTE P.M.B. 2191, KADUNA
APPLICATION FOR ADMISSION INTO

CARD PIN N0:

PHB4272469600ADM

Two Passport Photographs MUST be attached here. Write your Name and Number at the back

POSTGRADUATE DIPLOMA IN EDUCATION 2013 ACADEMIC SESSION
SURNAME
OYEWOLE

OTHER NAMES
SEGUN SUNDAY

DATE OF BIRTH
6-11-1986

SEX
MALE

MARITAL STATUS
SINGLE

EMAIL ADDRESS oyewole_segun@yahoo.com STATE OF ORIGIN
OSUN

LOCAL GOV.OF ORIGIN
ISOKAN

GSM NUMBER
08066477221

STATE OF RESIDENCE
OYO

PROPOSED LOCATION OF STUDY N. T. I. APPROVED STUDY CENTRE
MUFUTAU LANIHUN COLLEGE OF EDUCATION, IBADAN

NAMES OF SCHOOLS ATTENDED 1. 2. 3.
LOYOLA COLLEGE, IBADAN OSUN STATE COLLEGE OF TECHNOLOGY ESA-OKE OLABISI ONABANJO UNIVERSITY, AGO-IWOYE.

FROM
2000 2004 2008

TO
2004 2007 2011

POSTGRADUATE DIPLOMA IN EDUCATION PROGRAMME HIGHEST QUALIFICATION OBTAINED
OTHER (EQUIVELENT)

QUALIFICATION TYPE YEAR OF GRADUATION GRADE OBTAINED

BUSINESS ADMINISTRRA

2011

2ND CLASS UPPER

Copies of relevant Credentials MUST be attached PLEASE also note the following :1. Write the PIN NUMBER on the Bank Teller 2. Attach the Bank Teller to this Form

P.T.O.

DECLARATION :
(a) (b) (c) the particulars given on this form are to the best of my knowledge correct; if admitted into any of the Diploma Programme, I shall regard myself bound by the regulations of the N.T.I.; if at any time, the N.T.I. is reasonably satisfied that any of the information I have given on this form is false or incorrect, I will be required to withdraw from the Programme or be liable to prosecution or both.

............................................................ Signature of Applicant

................................................ Date

FOR OFFICE USE ONLY
(i) (ii) (iii) (iv) (v) (vi) Photocopies of ALL relevant Credentials are attached .......................................... The Scratch Card PIN agrees with the Number on this Form ................................ Copy of the Cashier's Bank Teller is attached ..................................................... Approved Subjects of Study............................................................................... Name of Verification Officer .............................................................................. Signature of Verification Officer ..................................................Date................

(vii) Signature of Study Centre Manager .............................................Date................ (viii) Signature of State Co-ordinator ...................................................Date................ (ix) Signature of Zonal Co-ordinator ...................................................Date..................