Private Mail Bag

KWAME NKRUMAH UNIVERSITY OF University Post Office

SCIENCE AND TECHNOLOGY Kumasi-Ghana

+233 3220 60444

+233 3220 61831
Online Application Form
06 July, 2019

Please Indicate Your Envelope Number At The Back Of Your EMS Envelope

Add photocopies of all related documents, certificates & results

Keep a copy of this printout for any future enquiry.

Personal Information
Envelope No: LAW/0555
Applicant ID: 20669872
Admission Group: Applying as Undergraduate Ghanaian
Students for (BA/BSC/BFA/LLB ETC.)
Application Mode: SSSCE/WASSCE

Title: Miss

Is this your passport size Surname: DZADEY

photograph? Other Names: FAFA PAMELA
Inappropriate Passport
size Picture Could deny Date of Birth: 30 April, 2001
you admission. Female
Gender:
Marital Status: Single

Home Country: Ghana

Home Region: VOLTA
Present Occupation: STUDENT
Phone Number: +233 243474956
Email Address: FAFAPAMELA214@GMAIL.COM
Postal Address: BUGUDON AMERIGOLD LIMITED P. O
BOX GP 4107 GREATER ACCRA GHANA
Residential Address: CROWN PRINCE ST. 7 STREET 7
GREATER ACCRA

Guardians Information
Name: Mr. KWAME DZADEY
Relation to Applicant: Father
Occupation: INDUSTRIALIST
Phone Number: +233 243474956
Email Address: KWAMEBCL@GMAIL.COM
Address: CROWN PRINCE ST 7 STREET 7
GREATER ACCRA GHANA

Programme Choices
Choice Programme Stream
First LL.B (532) Regular
Second BA. POLITICAL STUDIES (894) Regular
Third BA. ECONOMICS (795) Regular
Fourth BA. ENGLISH (794) Regular

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Choice for Hall of Residence

First Choice REPUBLIC HALL

Second Choice QUEENS HALL
Third Choice UNITY HALL

Educational Background

Institution Programme Pursued Duration

KWEGYIR AGGREY SNR. HIGH GENERAL ARTS October, 2016 - June, 2019
TECH

Exam Result

Exam Type Sitting Exam Year Index Number

WASSCE May/June (School) 2019 0030305279
(GHANAIAN)

Subject Grade
Mathematics (Core) Awaiting
Integrated Science Awaiting
Social Studies Awaiting
English Language Awaiting
Literature in English Awaiting
Economics Awaiting
Government Awaiting
Christian Religious Studies Awaiting

Please Note That EXAMINATION DESCRIPTION(ie. Index No., Year of exam, etc.) will be used to pick
RESULTS directly from The West African Examination Council (WAEC). CHECK For its Validity.

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 IMPORTANT

AN APPLICANT WHO MAKES A FALSE STATEMENT OR WITHHOLDS RELEVANT

INFORMATION MAY BE REFUSED ADMISSION. IF HE HAS ALREADY COME INTO THE
UNIVERSITY, HE WILL BE WITHDRAWN.

DECLARATION

I, MISS DZADEY FAFA PAMELAcertify that the information provided above is valid and will be
held personally responsible for its authenticity and will bear any consequences for any invalid
information provided

Date of Print Application ID Envelope Number Signature of Applicant

25 Aug, 2019 20669872 LAW/0555 ..........................................

Corroborative Declaration

PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE YOU ENDORSE THIS FORM

1. This Declaration should be signed by a person of high integrity and honour who must also endorse at least
one of the candidate's passport-size photographs on the reverse side and also satisfy himself/herself that the
examination Description and grades indicated on the form by the applicant are genuine.

2. The application will not be valid if the declaration below is not signed.

3. If the declaration proves to be false, the application shall be rejected; if the falsity is detected after
admission, the student shall be dismissed.

I hereby declare that the photograph endorsed by me is the true likeness of the applicant MISS DZADEY
FAFA PAMELAwho is personally known to me. I have inspected his/her certififcates and EXAMINATION
DESCRIPTION against the result indicated on the form and I am satisfied that they are genuine and the name
that appears on them is EXACTLY the same as that by which he/she is officially/personally known to me.

SIGNATURE.............................................................................................................................................

DATE........................................................................................................................................................

NAME (BLOCK LETTERS).....................................................................................................................

OCCUPATION.........................................................................................................................................

POSITION.................................................................................................................................................

CONTACT NUMBER (S) .......................................................................................................................

ADDRESS & OFFICIAL STAMP..........................................................................................................

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