Note: please send completed form as email attachment to: marcopolo63_2003@yahoo.com

OSUN STATE UNIVERSITY, OSOGBO

 DOCTORAL STUDENTS’ TRAINING PROGRAMME

 PERSONAL INFORMATION

(To be completed by Doctoral Trainee Fellow)

1. SURNAME……………………………………………………………………………………………

2. OTHER NAMES……………………………………………………………………………………….

3. PLACE & DATE OF BIRTH………………………………………………………………………….

4. SEX…………………………………………………………………………………………………….

5. MARITAL STATUS…………………………………………………………………………………..

6. RELIGION……………………………………………………………………………………………..

7. CONTACT ADDRESS………………………………………………………………………………..

8. TELEPHONE…………………………………………………………………………………………..

9. E-MAIL ADDRESS……………………………………………………………………………………

10. HOME TOWN………………………………………………………………………………………..

11. LOCAL GOVERNMENT AREA……………………………………………………………………

12. NEXT OF KIN………………………………………………………………………………………

              RELATIONSHIP………………………………………………………………………………

             ADDRESS OF NEXT OF KIN…………………………………………………………………

             TELEPHONE NUMBER……………………………………………………………………….

13. EMPLOYMENT RECORDS:

14. INSTITUTIONS ATTENDED WITH DATES

15. CATEGORY OF DOCTORAL PROGRAMME……………………………………………………

16. PROPOSED DISCIPLINE/COURSE OF STUDY…………………………………………………

17. STATE IF YOU HAVE SECURED ADMISSION:

               Name of University:

               Address of University:

               Course for which admission is secured:

               Duration of study:

               Date of commencement:

               Tuition fee payable:

               Other fees payable:

18. PROPABLE DATE OF DISENGAGEMENT FROM YOUR PRESENT WORK………………..

19. BOND: You are expected to enter into a bond with the University to serve two years for a one year programme. This would be finalised by agreement before the commencement of the sponsorship.

Please note that the following fees and allowances will be paid by the University:

(i)                   Full tuition fees

(ii)                 Maintenance allowance

(iii)                Book allowance

(iv)               Internet access allowance

(v)                 Other fees approved by the training institution

(vi)               Thesis preparation allowance

(vii)              Return economy air fare (for those sponsored overseas)

(viii)            Warm clothing allowance (where applicable)

20. AFFIRMATION: I affirm that the information given above is true and correct.

DATE……………………………………..

Caution: Any false declaration made by you will lead to automatic withdrawal of the sponsorship and will be reported to relevant authorities for possible prosecution.