Diploma – CLICU

Full Name *

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Phone No. *

Email *

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Local Government *

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Date of Birth *

Gender

Marital Status *

Course Applied For *

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Certification *

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Entry Level *

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Mode of Lectures *

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Church Name *

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Pastor Tel. No.

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Name of Referee *

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Reference Tel. No.

Your Expectation from the University

How did you get to know us *

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Signature

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Attestation *

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I promise to abide by the rules and regulations guiding my admission into this University. I promise to display a very high sense of responsibility. I agree that my admission can be terminated at any point in time if I am found wanting in speech and character.