PERSONAL DATA FORM
   
Fields Marked with * are compulsory
 
PERSONAL PARTICULARS
   
       
    PIN *  
    PASSWORD *  
    CONFIRM PASSWORD *  
    EMAIL *  
    CONFIRM EMAIL *  
    SELECT PROGRAM  
    SELECT LEVEL  
    LAST NAME *  
  FIRST NAME *  
    MIDDLENAME  
  SEX  
    DATE OF BIRTH  
  STATUS  
  STATE OF ORIGIN  
  LOCAL GOVERMENT AREA *  
  PLACE OF BIRTH  
  RESIDENTIAL ADDRESS  
    PHONE *  
  NEXT OF KIN  
  NEXT OF KIN PHONE NO  
    UPLOAD PICTURE No more than 15kb