Registration Form

Student Application Form

Fill out the form carefully for registration, Your Admission to study in Benin republic is a CLICK away
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Student E-mail*
Mobile Number*

Area CodePhone Number
parent/guidance name*
PARENT/GUARDIAN Number*

Area CodePhone Number
COURSE OF STUDY*
SELECT YOUR FIRST AND SECOND CHOICE OF COURSE
CHOICE OF INSTITUTION*
SELECT YOUR CHOICE OF INSTITUTION
O' LEVEL CERTIFICATE*
APPLICATION TYPE*
DEGREE TYPE*
WHO REFERRED YOU
Should be Empty:

Student Application Form