Great GoldMine Academy

Your Child a Treasure Worth Maximizing

Application Form

Note: Ensure your details are correctly filled. You will no longer be able to edit your application after submission

Basic Information

Surname

First Name

Other Names

Date of Birth

Place of Birth

Contact Information

Phone Number

Email Address

Nationality

State of Origin

L.G.A of Origin

Home Address

Educational Information

Primary School Attended

Class Applying For

School Last Attended

Proposed Profession After Graduation

Parents/Guardian Information

Parents/Guardian Name

Parents/Guardian Home Address

Parents/Guardian Phone Number

Parents/Guardian Email Address

Medical Information

Do You Have Any Medical Condition or Special Need?

Please specify the condition and specify which hospital or doctor should be contacted if the need arises

Are You Allergic To Any Medication?

Please Specify Your Allerg(ies).