APPLY FOR BURSARY

Application form for 2015 Prof. Ajibefun
bursary form is out. An eligible Student of
Okunmo can obtain this form at FOSA
Secretariat.
PERSONAL DATA:
1. NAME:……………………………………….
2. SCHOOL:……………………………………
3. MATRIC NO:……………………………….
4. COURSE:…………………………………….
5. TOWN:……………………………………….
6. LOCAL GOVERNMENT:…………………
7. STATE OF ORIGIN:………………………
8. EMAIL ADD:……………………………….
9. PHONE NUMBER:……………………….
10. CGPA:…………………………………….
BANK DETAILS:
Bank name:…………………………………..
Account name:……………………………….
Account number:…………………………….
OFFICIAL USE ONLY
I recommend ………………………………….as
bonafide member of FOSA and has
perform his/her responsibility to the
association and the community.
………………. ………………………
FOSA SEC. FOSA PRESIDENT
Sign/Date. Sign/Date

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