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2210072

APP NO.________________________

KATSINA STATE SCHOLARSHIP BOARD


STUDENT INTERVIEW FORM
FRESH STUDENT

2022/2023
SESSION: ______________________________

SECTION I

ABULLAHI ZAINAB SALISU


NAME___________________________________________________________

FEMALE 20 MALUMFASHI
SEX____________AGE_______LGA____________________________________

STERLING BANK
BANK NAME______________________________________ACCOUNT 0093149407
NUMBER________________________

KHUDDAM SCHOOL OF HEALTH TECHNOLOGY KATSINA


INSTITUTION______________________________________________CATEGORY______________________ ND

SCIENCE
COURSE DISCIPLINE__________________________COURSE DIP PHARMACY - (3) YRS
NAME_________________________________

2022/2023 09160652136
START SESSION_________________________________GSM______________________________________

ABATTOR KATSINA
PERMANENT ADDRESS_____________________________________________________________________

SECTION II
RECORD OF EMPLOYMENT
NAME OF EMPLOYEE (IF ANY) _______________________________________________________________________________________

SECTION III
DECLARATION

I CERTIFY THAT I AM WORKING/NOT WORKING WITH THE GOVERNMENT AND THAT PARTICULARS GIVEN IN SECTION I
& II ABOVE ARE CORRECT AND ALSO AGREE TO ABIDE BY THE DECISION OF THE SCHOLARSHIP BOARD

_____________________________ _____________________________
DATE SIGNATURE

SECTION IV
FOR OFFICIAL USE ONLY

APPROVED/NOT APPROVED__________________________________________________________________

SPECIFY REASON (IF NOT APPROVED)__________________________________________________________


_______________________________________________________________________________________
NAME__________________________________SIGNATURE____________________DATE_______________
DOP___________________________________SIGNATURE____________________DATE_______________

E/S____________________________________SIGNATURE____________________DATE_______________
2210072
APP NO.________________________

ACKNOWLEDGEMENT SLIP

ABULLAHI ZAINAB SALISU


NAME___________________________________________________________

KHUDDAM NAME
INSTITUTION SCHOOL OF HEALTH TECHNOLOGY KATSINA
_______________________________________________________________________________________

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