+237 651 56 33 20

KINGS HIGHER INSTITUTE +237 688 89 96 66

+237 651 56 33 20
Authorization No: 22-05614/L/MINESUP/SG/DDES/ESUP/SDA/MF
Motto: Professionalism, Excellence and Innovation
Recent
ff

UNDERGRADUATE APPLICATION FORM Student Number

PLEASE SECLECT APPROPRIATE CATEGORY FOR APPLICATION PROCESS.
I AM APPLYING FOR
□ FULL TIME STUDENT STATUS □PART TIME STUDENT STATUS
PERSONAL DATA (Please print clearly)
STUDENT”S NAME
Identity card number
FIRST NAME MIDDLE NAME LAST NAME
PROGRAM OF STUDY
NATIONALITY REGION DATE OF BIRTH
SCHOOL OF HEALTH SCIENCES
GENDER: □ MALE □ FEMALE I AM APPYING FOR: □ OND □ HND □ DEGREE
□ NURSING
PERMANENT ADDRESS
□ MIDWIFERY
□ PHYSIOTHERAPY
REGION TOWN/CITY STREET □ MEDICAL LABORATORY
□ PHARMACY TECHNOLOGY
□ NUTRITION AND DIETETICS
MOBILE NO HOME NO WORK NO
□ HEALTHCARE MANAGEMENT
NAME OF PARENT GUADIAN OR SPOUSE
□ MEDICAL IMAGING TECHNOLOGY
FIRST NAME MIDDLE NAME LAST NAME SCHOOL OF AGRICULTURE&FOOD SCIENCES
□ AQUACULTURE
□ AGRIBUSINESS
□ CROP PRODUCTION
REGION TOWN/CITY STREET
□ FOOD TECHNOLOGY
□ ANIMAL PRODUCTION
MOBILE NO HOME NO WORK NO □ AGRICULTURAL ENGINEERING
LANGUAGE SPOKEN □ AGRICULTURAL PRODUCTION TECHNOLOGY
□ ENGLISH

PREVIOUS EDUCATION DETAILS (Please tick the box below and attach documents)

CERTIFICATE NAME OF CENTER CENTER NUMBER YEAR SUBJECTS

GCE ORDINARY LEVEL /CAP
GCE ADVANCE LEVEL/BACC
DIPLOMA/CAPIEME
HIGHER NATIONAL DIPLOMA
□ FRENCH
ORTHER
DECLARATION
I_________________________________________________________ hereby declare that all information in this
form is correct to the best of my knowledge. Any false or incomplete information given in this form will
automatically disqualify me from being considered for admission or continuing with any course of study at Kings
Higher Institute. I shall accept as final decision of the Institution with regard to my Department/Program of study.

Fueling zeal with excellence to ignite innovation

 +237 651 56 33 20
KINGS HIGHER INSTITUTE +237 688 89 96 66
+237 651 56 33 20
Authorization No: 22-05614/L/MINESUP/SG/DDES/ESUP/SDA/MF
Motto: Professionalism, Excellence and Innovation

0Student Number
UNDERGRADUATE APPLICATION FORM
PLEASE SELECT APPROPRIATE CATEGORY FOR APPLICATION PROCESS
I AM APPLYING FOR THE SCHOOL OF
□ FULL TIME STUDENT STATUS □ PART TIME STUDENT STATUES
PERSONAL DATA (Please print clearly) STUDENT”S NAME

Identity card number FIRST NAME MIDDLE NAME LAST NAME

PROGRAM OF STUDY
NATIONALITY REGION DATE OF BIRTH SCHOOL OF HEALTH SCIENCES
I AM APPYING FOR: □ OND □ HND □ DEGREE
GENDER: □ MALE □ FEMALE □ NURSING
PERMANENT ADDRESS □ MIDWIFERY
□ PHYSIOTHERAPY
REGION TOWN/CITY STREET □ MEDICAL LABORATORY
□ PHARMACY TECHNOLOGY
□ NUTRITION AND DIETETICS
MOBILE NO HOME NO WORK NO □ HEALTHCARE MANAGEMENT
NAME OF PARENT GUADIAN OR SPOUSE □ MEDICAL IMAGING TECHNOLOGY
SCHOOL OF AGRICULTURE&FOOD
FIRST NAME MIDDLE NAME LAST NAME
SCIENCES
□ AQUACULTURE
□ AGRIBUSINESS
REGION TOWN/CITY STREET □ CROP PRODUCTION
□ FOOD TECHNOLOGY
MOBILE NO HOME NO WORK NO □ ANIMAL PRODUCTION
LANGUAGE SPOKEN □ AGRICULTURAL ENGINEERING
□ ENGLISH □ AGRICULTURAL PRODUCTION
TECHNOLOGY

PREVIOUS EDUCATION DETAILS ( Please tick the box below and attach documents)
CERTIFICATE NAME OF CENTER CENTER NUMBER YEAR SUBJECTS
GCE ORDINARY LEVE/CAP

GCE ADVANCE LEVEL/BACC

DIPLOMA/ CAPIEME

HIGHER NATIONAL DIPLOMA

DECLARATION
I_________________________________________________________ hereby declare that
all information in this form is correct to the best of my knowledge. Any false or incomplete
information given in this form will automatically disqualify me from being considered for
admission or continuing with any course of study at Kings

Fueling zeal with excellence to ignite innovation

 +237 651 56 33 20
KINGS HIGHER INSTITUTE +237 688 89 96 66
+237 651 56 33 20
Authorization No: 22-05614/L/MINESUP/SG/DDES/ESUP/SDA/MF
Motto: Professionalism, Excellence and Innovation

Fueling zeal with excellence to ignite innovation