Al-Ihsan Noble Scholars | Excellence in Education

APPLICATION FORM

INSTRUCTION:
Attach 2 recent passport-size photographs.
Complete form in block letters.

INFORMATION ON STUDENT

Name

Surname

Other Names

Date of Birth

Day

Month

Year

Sex

Nationality

AFFIX
PASSPORT
PHOTOGRAPH

State of Origin

Religion

Class on Admission

SCHOOLS ATTENDED	FROM	TO

NEXT OF KIN

Name

Surname

Other Names

Relationship with child

Address

Tel

WHOM DOES THE CHILD LIVE WITH?

(Father, Mother, Guardian, Father and Mother)

PLEDGE

I pledge to abide by all rules and regulations of Al-Ihsan

Student's Signature

Date

Parent/Guardian's Signature

Date

HEAD OF SCHOOL'S RECOMMENDATION

After assessing the applicant, I find him/her fit for admission to class

Head of School's Signature/Official Stamp

Date

MEDICAL REPORT

Blood Group

Genotype

Do you have any special health problem? (Yes/No)

OFFICIAL USE ONLY

Date application was received

ITEMS INCLUDED: YES or NO

Birth Certificate

Passport Photograph

Copy of last report

RECEIVING OFFICER

Name

Signature

Date

FEES PAID	RECEIPT NO	DATE	RECEIVING OFFICER
FEES PAID	RECEIPT NO	DATE	Name	Signature