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Application Form

APPLICATION FORM FOR ADMISSION

SCHOOL OF POST BASIC CRITICAL CARE NURSING

UNIVERSITY OF ABUJA TEACHING HOSPITAL, GWAGWALADA, ABUJA

1. Surname*
2. Other Names*
3. Date of Birth*
4. Sex*
5. Maritial Status
6. Recent Passport Photograph
7. Upload Remita receipt or Print out from the bank
8. Local Government
9. State Of Origin
10. Nationality
11. Religion
12. Address
13. Telephone*
14. Email*
15. Current Place of Employment
16. Date of Employment
17. Next of KIN*
18. Relationship
19. Address
20. NOK Telephone no.
21. Sponsor(s)
22. Address of Sponsor(s)
23. Sponsor Telephone no.
24. Type of Sponsorship
25. INSTITUTIONS ATTENDED WITH DATES: (Starting with the most recent)
S/N - NAME OF INSTITUTION - FROM - TO
26. QUALIFICATIONS OBTAINED WITH DATES:
S/N - QUALIFICATION - DATE - REMARK
27. NAME AND ADDRESS OF REFEREES
(Original copies of credentials must be presented for screening during the interview)
Declaration*
- I declare that the information given above is correct

For enquiries, please contact the school on 08056206826, 08055475957, 08033895519 and 08036767591 or by email – intensecare@yahoo.com

EXAMINATION DATE: THURSDAY, 19th AND FRIDAY, 20th MAY, 2022

(Original copies of credentials must be presented for screening during the interview)

Gwagwalada, P.M.B. 228, Abuja NIGERIA

+234 704 004 5614

info@uath.gov.ng