Application for Admission to Office Use
Registration No.
GRADUATES REGULAR MEMBERSHIP
QUALIFYING EXAMINATION COURSE
1.0 PERSONAL DETAILS
1.1 ______________________________ 1.9 Residential Address
Surname
1.2 ______________________________
Other Names
1.3 ______________________________
Sex (Male/Female)
1.4 ______________________________ 1.10 Correspondence Address
Date of Birth
1.5 ______________________________
Marital Status (Married/Single)
1.6 (Male/Female)
______________________________
Nationality
1.7 ______________________________ 1.11 ______________________________
State of Origin (If Nigerian) Telephone Number
1.8 ______________________________ 1.12 ______________________________
Local Government Name E-mail
2.0 BASIC EDUCATIONAL QUALIFICATION
2.1 Name of Examination:__________________________________________________
(WASC/GCE/SSCE/NECO etc.)
2.1 Detailed Results:
Year Subjects Grade Year Subjects Grade
1
3.0 HIGHER ACADEMIC/PROFESSIONAL QUALIFICATIONS
Name of Awarding Institution Discipline Qualification Grade Year Graduated
4.0 PAST/PRESENT EMPLOYMENTS
Date Employed
Name/Address of Employers Position Held
From To
5.0 FACULTIES OF SPECIALISATION
(Mark “X” in the box against the faculty of specialisation of your choice)
Faculty of Corporate Administration
Faculty of Financial Administration
Faculty of Human Resource Administration
Faculty of Public Administration
6.0 METHOD OF STUDY
(Mark “X” in the box against the method of study of your choice)
Full Time Part Time (Weekends) Distance Learning
7.0 STUDY CENTRE
(Note if your Method of Study is Distance Learning, your Study Centre is automatically the
Nigerian College of Administration)
Name of Study Centre
2
8.0 COMMENCEMENT DATE
(Mark “X” in the box against the commencing date of your choice)
January May September
9.0 SUPPORTING DOCUMENTS
Submit your completed application form with the following items, without which your
application for admission will not be processed.
9.1 Receipt evidencing purchase of this form
9.2 Birth Certificate/Affidavit
9.3 One copy of each Educational Qualification
9.4 Two recent Passport Photographs
10.0 DECLARATION
I declare that the information provided in this Form is correct. I undertake to abide by the
rules and regulations of the College and Chartered Institute of Administration, comply with
minimum entry requirements and pay all fees as and when due; failing which my student
registration shall be automatically cancelled by the College. I accept that fees paid are not
refundable no matter the circumstances.
Signature of Applicant Date