Horatio Oritsejolomi Thomas Foundation Application Form

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Please complete the form below: note: all fields marked '*' are Required

1. Full Name(Include Prefix Mr/Mrs/Ms./Dr/ followed by Surname first before other names): *

2. Full Address(Include State) *

Tel: *

Email: *

3. Your currently Level and Department *

Pre 2nd MB(Yes/No) and If Yes how many years to MBBS degree?

Post 2nd MB(Yes/No) and If Yes how many years to MBBS degree?

4. Grade(s) at last examination: Anatomy Grade and Date

Physiology Grade and Date

Subject & Grade(Please list below):

5. Agreement *

I confirm the above details to be true and also agree to the Horatio Oritsejolomi Thomas Foundation contacting CMUL to confirm my examination grades and that I have either applied to CMUL for financial assistance or shown in some other way that I am unable to complete the MBBS degree course due to financial hardship.

Required

For Enquiry Please:
Email: info@horatiooritsejolomithomasfoundation.org

PALM SERVICES LIMITED
Challenge Bookshop House
371, Agege Motor Road,
Challenge Bus Stop
Challenge - Lagos.
P.O. Box 3558, Festac Town
Lagos.

*NOTE: All applications must be submitted on or before 30th of June each year.

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