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PROFESSIONAL EXAMS CLINIC
( A
division of Ogundoro Leadership Trainers & Management Consultants)
3, Tonade Street , Ikeja , P.O. Box 265, 0shodi, Lagos, Nigeria
ENROLMENT FORM
(CONFIDENTIAL) SURNAME:__________________________________OTHER
NAMES_______________________-______________ SEX:____________________________________________________MARITAL STATUS:________________________ DATE OF BIRT________________________________________________________________NAME & ADDRESS OF EMPLOYER (ORGANIZATION):______________________________________________________________________________________________________________________________________________________ POST HELD:___________________________________________________________________________________ RESIDENTIAL ADDRESS:_____________________________________________________________________ ______________________________________________________________________________________
DATE
OF
EXAM_________________________________________________________________________________________________________
SPONRSHIP
(SELF OR
EMPLOYER):______________________________________________________________________ MODE
OF STUDY WEEKEND_______EVENINIG______SANDWICH______PRIVATE TUTORIAL____ FULL
TIME___ (TICK) SUBJECT(S)
TO BE OFFERED 1
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/ SECTION OF EXAM /PROGRAMME:_____________________________________________________
OTHER ACADEMIC /PROF. PROGRAMME(S)BEING UNERTAKEN NOW (SPECIFY
INSTITUTIONS:_____________ ________________________________________________________________________________________________________ DURATION
(SPECIFY
DATES):__________________________________________________________________________ MODE
OF
STUDY:____________________________________________________________________________________ FROM
WHAT SOURCE(S) DID YOU KNOW ABOUT THIS CLINIC?
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I
.do hereby
confirm that l have read through therein willing ly and make my self subject to
their application. I also confirm the correctness of all the data I supplied on
this enrolment form.
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