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STUDENT VERIFICATION EXERCISE

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Fields marked with an * are required.

Student Information
College :
Faculty :*
Department :*
Level :*
Course of study :*

Matric No :*
Last Name :*
First Name :*
Middle Name :

Year of Entry :*
Mode of Entry :*
Campus :*
Date of Birth :*	?
Religion :*
Gender :*
Marital Status :*
State of origin :*
Place of birth :*
Blood group :*

Address 1 :*
Address 2 :
Country :*
State :
City :*
Local Govt. :
Phone 1(Mobile) :	?
Phone 1(Mobile) :
Phone 2(Landline) :
Phone 2(Landline) :
Email :	?
Fax :
Postal Address :