Modal University College

The Admission Office, P.O. Box SK 172 Sogakope, Volta Region, Ghana

Mob. +233 240766893, +233 207686304

Website: www.modalcollege.com

1PERSONAL INFORMATION
2ACADEMIC INFORMATION
3DECLARATION

PERSONAL DETAILS

Surname

First Name

Other Names

Title

Miss

Mrs.

Date of Birth:

Place of Birth

Nationality

Gender

Male

Female

Marital Status

Single

Married

Religion

Phone

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Number

DECLARATION

Declaration by applicant. I declare that the statements on this form are correct. I understand that any offer of admission may be withdrawn if the information provided is fraudulent or if I cannot provide documentary evidence.

For assistance filling forms, call: 0240766893