Application Form – Grandmont Learning Academy

Online Admission Form

Kindly fill form below and submit the application after which you will be re-directed to the payment page to make payment for the admission form.

The Admission Form Cost #5,000 Only.

Application Form

Class to Enroll

Sex

Male

Female

Pupil Last Name

Pupil First Name

Date of Birth

Religion

Religion Denomination

LIN (Learner Identification Nos.)

State of Origin

Town

Present School

Previous Class

Age

Blood Group

Genotype

Allergy to Any Drug (Mention it)

Any Previous Surgery

Yes

If YES, Where and When:

Transfer Certificate/Academic Record

Yes

Name of Father/Guardian

Home Address

Occupation

Office Address

Nationality

Phone Number

Name of Mother/Guardian

Home Address

Occupation

Office Address

Nationality

Phone Number

Next of Kin

Address

Phone Number

If you are human, leave this field blank.