Scepter
Holders
™
REGISTRATION
FORM
The Field with Asterisk (*) is Compulsory
Bio Data
Academics
Contact
Others
Student Details
Upload Passport
(File format .jpg)
Application ID:
Surname
*
Firstname
*
Middle Names
Village of Origin
LGA of Origin
*
State of Origin:
*
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Beyelsa
Benue
Cross River
Delta
Ebonyi
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kwara
Lagos
Nasarawa
Ogun
Ondo
Osun
Oyo
Rivers
Sokoto
Taraba
Yobe
Zamfara
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Nationality:
*
Nigerian
Other
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If Other Specify
Gender
*
Male
Female
Birthday:
*
Medical Fitness:
*
Select
Very Poor
Poor
Good
Very Good
Excellent
Last School Attended:
*
Last/Current Class :
*
Select
Primary 4
Primary 5
Primary 6
JSS 1
JSS 2
JSS 3
SSS 1
SSS 2
SSS 3
Proposed Class:
*
Select
JSS 1
JSS 2
JSS 3
SSS 1
SSS 2
SSS 3
Contact Details
Parent/Guardian Name
House Number
Street Name
City
State
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Beyelsa
Benue
Cross River
Delta
Ebonyi
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kwara
Lagos
Nasarawa
Ogun
Ondo
Osun
Oyo
Rivers
Sokoto
Taraba
Yobe
Zamfara
-Select-
Country
Nigeria
Other
-Select-
Email
*
Contact Phone Number
*
Others
Preferred Exam Date
*
How did You Hear About Us
*
Finish