NEW MEMBERS

Our membership comprises a wide range of professional managers, advisers and teachers at all levels in the public sector, universities and in the private sector.

View the list of new members
here >>

application form

Before you fill the application form PLEASE read the following instructions:

Make the Payment of the Registration Fee to the Institute's Account.
Account name: CILGPAN
Account number: 6116100707
Bank Name: Zenith Bank
Fill out the form below
Click the submit button
Print the document(completed form) that pops up
Submit the printed form along with the Bank teller to the Institute.

You may fill out the Application form now.

Personal Information:

Surname:

Middle Name:

First Name:

Business Address:

Office Tel. No.:

Home Address:

Home Tel. Number:

Date of Birth:

Age:

Sex:

Place Of Birth:

Religion:

Marital Status:

No. of Children:

Their Ages:

State of Origin:

Nationality:

Local Government Area:

Married women should complete the detail marked **

** Maiden Name:

Exam Title:

Exam Period:

please indicate May or November.

Educational Chronology

Primary School Details:

Name:

Address:

From:

To:

Certificate Received:

Please fill the following portion if you attended more than one Primary School.

Name:

Address:

From:

To:

Certificate Received:

Secondary School Details:

Name:

Address:

From:

To:

Certificate Received:

Please fill the following portion if you attended more than one Secondary School.

Name:

Address:

From:

To:

Certificate Received:

College of Technology/Education Details:

Name:

Address:

From:

To:

Certificate Received:

Please fill the following portion if you attended more than one College.

Name:

Address:

From:

To:

Certificate Received:

University Details

Name:

Address:

From:

To:

Degree Received with date:

Please fill the following portion if you attended more than one University.

Name:

Address:

From:

To:

Degree Received with date:

Post-Graduate Education Details:

Name:

Address:

From:

To:

Degree Received with date:

Please fill the following portion if you have more than one Post-Graduate Degree.

Name:

Address:

From:

To:

Degree Received with date:

Are you sitting for examinations at the end of the year?

State YES or NO

Explain

Do you expect to qualify for your degree, diploma or certificate this year?

State YES or NO

If yes give Details

Have you been excluded or are you liable for exclusion on academic or any other grounds from any tertiary institution or faculty and/or course within such institution following a previous enrolment?

State YES or NO

If yes please explain:

Has there been a break in your studies since leaving schools, or since your previous tertiary studies?

State YES or NO

If yes give brief particulars:

GCE O/LEVEL or WASC/NECO Examination Passed:

EXAM Name:

EXAM Date:

Center Number:

EXAM Number:

SUBJECT		GRADE
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GCE A/LEVEL or HSC Examination Passed or Any Other Qualification:

EXAM Name:

EXAM Date:

Center Number:

EXAM Number:

SUBJECT		GRADE
SUBJECT		GRADE
SUBJECT		GRADE
SUBJECT		GRADE
SUBJECT		GRADE
SUBJECT		GRADE