Online Application

Name *

First

Middle

Last

Previous Name:

Sex: *

Male Female

Permanent (Home) Address: *

Address Line 1 *

City *

State *

Zip Code *

Country *

Date of Birth *

Nationality: *

Phone No *

Email Address *

Age Last Birthday *

Qualifications

Basic Qualification *

Name of Institutions *

Duration of Course *

Date of Qualification

Registered No./License No.

Post-Basic Qualifications

Name of Institutions

Duration of Course

Date of Qualification

Registered No./License No.

Additional Qualifications

SPECIALTY/FACULTY:

MEDICAL AND SURGICAL NURSING MATERNAL AND CHILD HEALTH AND MIDWIFERY MENTAL HEALTH AND PSYCHIATRIC NURSING COMMUNITY HEALTH NURSING (Tick the Faculty to which you are applying)

Professional Experience

Designation / Institution with Date

Signature of Applicant *

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Referees (Must be one professional Nurses and one other person to whom you are known for at least 5 years) *

(Insert Name , Qualification/Status , Address )

(1) This Form, when completed, must be returned in either online or duplicate to be addressed to Executive Secretary, West African College of Nursing, 6, Taylor Drive (off Edmond Crescent), P.M.B.2023, Yaba, Lagos, Nigeria. on or before 31st July. Late submission attracts penalty of $10.

(2) The application must be accompanied by a non-refundable application fee of $30 or N20, 000.00 payable to West African College of Nursing. Account Details: First Bank Plc, Account Name – West African College of Nursing Account Number: Naira Account – 2003831052 and Dollar Account - 2003465262

(3) Two Passport size photographs must be scanned and attached.

(4) Photocopies of all credentials (certificates and current licence) must be enclosed and originals made available at the time of registration.

(5) You can scan and send to the attached email addresses: admission@wapcnm.com & wapcnmadmission@gmail.com

Attach proof of payment *

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Upload Passport *

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WEST AFRICAN POSTGRADUATE COLLEGE OF NURSES ANDMIDWIVES

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