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Federal Polytechnic Nekede | New Student


Application Form No

Generate HND Acceptance Fee Invoice

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Screening

Status:	`Pending`
Matriculation No.	`Pending`

Last Name

Other Names

Student Identity No

Date Of Birth

Have You Been Hospitalized Before?

If YES State Where You Where Hospitalized

If YES State Why You Where Hospitalized

If YES State When You Where Hospitalized

Have You Had Accident Before?

If YES State The Type Of Accident

If YES State Why You Had The Accident

If YES State When You Had The Accident And How Long You Were Hospitalized

Have You Had X-ray Before?

If YES State The Type Of X-ray

If YES State Why You Had The X-ray

If YES State When You Had The Xray

Are You Allergic To Any Drug?

Select Your Allergy For Each Drug And State The Type Of Reaction.

Chloroquine

State The Type Of Reaction Caused By Chloroquine On You

Maloxine

State The Type Of Reaction Caused By Maloxine On You

Fansidar

State The Type Of Reaction Caused By Fansidar On You

Metakelfin

State The Type Of Reaction Caused By Metakelfin On You

Penicillin

State The Type Of Reaction Caused By Penicillin On You

Paracetamol

State The Type Of Reaction Caused By Paracetamol On You

Please Specify Any Other Drug You Are Allergic To

Have You In The Past Suffered From Any The Following Ailment(Tuberculosis,Epilepsy/Convulsions,Measles,Asthma,Chickenpox,Diabetes,Hypertension,Ulcer)?

If YES , Indicate The Ailment And Date.

Tuberculosis

Select The Date You Had Tuberculosis

Epilepsy/Convulsion

Select The Date You Had Epilepsy

Measles

Select The Date You Had Measles

Asthma

Select The Date You Had Asthma

Chickenpox

Select The Date You Had Chickenpox

Diabetes

Select The Date You Had Diabetes

Hypertension

Select The Date You Had Hypertension

Ulcer

Select The Date You Had Ulcer

Have You Ever Coughed Out Blood?

Have You Ever Vomited Blood?

Have You Had Any Immunization In The Past?

If Yes, State The Type And When

Have You Had Any Surgery/operation?

If Yes, State The Type And When

Is Your Sight Good?

If You Use Glasses Please Specify Why

When Did You Start-using Glasses

Type Of Glasses You Are Using

Do You Have Any Physical Disability?

If Yes, Please Specify