Student Registration Form

Please complete this form clearly and accurately. Information provided will be treated confidentially and used to understand the student's circumstances and support needs.
Fields marked with * are compulsory. If a question does not apply to you, please enter "N/A".

A. Student Information

Student Code

Surname *

First Name *

Date of Birth *

Gender *

Male Female

Nationality *

Phone Number *

Email Address *

Student ID (if any)

Home Address *

B. School Information

Name of School *

Current Class/Year *

Education Level *

School Type *

State Private Other

School Email *

School Address *

Principal/Head Teacher *

Teacher/School Contact *

School / University Bank Details (optional)

Bank Name

Account Name

Account Number (10 digits for Nigerian banks)

C. Parent Information

Parent who has died *

None Mother Father Both Parents

Parent 1 Details

Name of Deceased Parent *

Date of Death *

Age of Student When Parent Died *

Cause of Death (optional)

Has student received bereavement support? *

Yes No

Please describe any important circumstances surrounding the loss or significant changes in the student's life since the parent's death *

D. Current Parent / Carer / Guardian Information

Who currently has responsibility for the student? *

Parent Relative Guardian Foster carer Other caregiver

If Other, please specify *

Carer/Guardian Surname *

Carer/Guardian First Name *

Relationship to Student *

Phone Number *

Email Address *

How long has the student lived with this carer? *

Home Address *

Is there a formal guardianship/care arrangement? *

Yes No

If yes, please provide details *

If neither parent is currently caring for the student, please explain the current care arrangement *

E. Family / Household Financial Circumstances

Parent Surname *

Parent First Name *

Parent's Occupation *

Parent's Employer/Business *

Parent's Estimated Monthly Income (NGN) *

Carer/Guardian's Occupation *

Carer/Guardian's Employer/Business *

Carer/Guardian Monthly Income (NGN) *

Other Household Income/Support *

Total Monthly Household Income (NGN) *

Number of People in Household *

Number of Children/Dependants *

Number Currently in Education *

Please list the children/dependants currently in education (name, age and school/class) *

Other significant financial responsibilities? *

Yes No

If yes, please explain *

F. Student's Current Needs

Please tick all areas where the student may require support. An amount is compulsory for every item you tick.

School fees / education costs Uniform / clothing Books / learning materials Food / basic needs Transport Emotional / bereavement support Mentoring / pastoral support

Other (optional)

Amount for Other (NGN) *

Further information about the student's current needs *

G. Academic Information

Current/Last Term Average *

Class Position *

Subjects of Strength *

Subjects Where Support Is Needed *

Awards / Achievements *

Attendance / School Concerns *

H. Student Wellbeing & Support

How would you describe the student's current wellbeing? (Optional)

Is there anything the school, family or programme should know to support the student appropriately? *

I. Student's Interests, Goals & Aspirations

Clubs / Sports / Activities *

Leadership / Community Activities *

What career would the child like to pursue in the future? *

What type of support would make the biggest difference to the student? *

J. Other Support / Funding

Is the student currently receiving financial assistance or another scholarship? *

Yes No

If yes, please provide details *

What financial or practical challenges is the family currently experiencing? *

K. Documents / Evidence

Please tick the documents you are providing (at least one is required) *

Proof of student identity / age School confirmation / student ID Evidence of parent's death Evidence of guardianship/care arrangement Evidence of income/financial circumstances

L. Consent & Declaration

I confirm that the information provided in this form is accurate to the best of my knowledge. I understand that the information may be used confidentially to assess the student's circumstances, eligibility for support, and appropriate safeguarding or pastoral needs.

I understand that information about the student's bereavement is sensitive and should only be shared with relevant people on a need-to-know basis.

Parent/Guardian/Carer Name *

Relationship to Student *

Signature (type full name) *

Date *

M. School / Institution Endorsement

Full Institution Name *

Principal/Head/Authorised Officer *

Full Institution Address *

Official Institution Telephone *

Official Institution Email *

Institution's Comments / Confirmation of the Student's Circumstances *

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