Dominican University Ibadan

Details of the Referrer
Name
Department/Unit
Phone Number
Email Address

Details of Referred Candidate
Name
Programme of Choice
UTME Score
JAMB Registration No.
Email Address
Phone number
Phone number of Parents/Guardians

Kindly indicate mode(s) of interaction with the candidate/parent/guardian

Phone call

Physical visit/interaction

Social media

Others

Account Details
Account Name
Account Number
Bank Name

Attestation

I hereby declare that the pieces of information supplied above are true and verifiable. I have also read, and therefore, accepted the attached terms and conditions associated with the scheme.

I agree to the above declaration

Date:

STUDENTS' REFERRAL CLAIM FORM