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Cornerstone International School

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					                    Cornerstone International School                                      Affix
                                 Asaba, Delta State                                      Passport

                                ADMISSION FORM
                         Fill this form correctly and legibly, in upper case.

APPLICATION FORM No: CISA………………………………………………………………………………………………………………………………………….

1.       Surname: …………………………………………………… Middle Name: ……………………………. Last Name: ………………………………

2.       Sex:                  Male                           Female

3.       Date of Birth: …….…/…………………/…………………………………… (mm/dd/yyyy)

4.       Place of Birth: ………………………………………………………………

5.       State of Origin: …………………………………………………….. LGA: ……………………………………………………………………………………..

6.       Nationality: ………………………………………………………………………………………………………………………………………………………………..

7.       Religion :………………………………………………………………………………………………………………………………………………………………………

8.       Parent/Guardian Name…………………………………………………………………………………………………………………………………………….

9.       Residential Address………………………………………………………………………………………………………………………………………………….

10.      Office Address………………………………………………………………………………………………………………………………………………………….

11.      Phone No ……………………………………………………………….…………………………………………………………………………………………………..

12.      Specimen Signature of the Child ………………………………………………………………………………………………………………………….

                                              DECLARATION
    I …………………………………………………………………………………………………………………………………………………………… undertake to
train my war/child in your school and to attend meeting of the PTA

………………………………………………………………….                                             ……………………………………………………….
     Signature                                                                  Date

                                         FOR OFFICE USE ONLY
1.    Date of Admission……………………………………………………………………………………………………………………………………………………………
2.    Class …………………………………………………………………………………………………………………………………………………………………………………..
3.    Admission No ……………………………………………………………………………………………………………………………………………………………………
4.    Are all requirements provided ……………………………………………………………………………………………………………………………………..
5.    Admission officer Remark …………………………………………………………………………………………………………………………………………….

				
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posted:5/29/2012
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