NUC/DAS/SSA/01

NATIONAL UNIVERSITIES COMMISSION

FORMAT ON STAFF AND STUDENT AUDIT

STAFF INFORMATION Passport Photo

(To be completed by staff)

SECTION A: INSTITUTIONAL INFORMATION

1. INSTITUTION:__________________________________________________________________

2. FACULTY:______________________________________________________________________

3. DEPARTMENT/UNIT:_____________________________________________________________

4. AFFILIATION:_______________________________________ DURATION:_________________
(e.g. Sabbatical, Leave of Absence, Secondment etc.)

SECTION B: PERSONAL DATA

4. STAFF NUMBER:______________________________________________________________

5. NAME:______________________________________________________________________
SURNAME FIRST NAME MIDDLE NAME(S)

6. FORMER NAME (If any):_________________________________________________________

SURNAME FIRST NAME MIDDLE NAME(S)

7. SEX: M/F 4. DATE OF BIRTH______/______/____ 5. NATIONALITY ________________

Day Month Year
8. STATE OF ORIGIN: ______________________________________________________________

9. Biometrics

Right thumb Right forefinger Left thumb Left forefinger

10. DATE OF 1st APPOINTMENT: (a) To this university: _______/_______/_______

Day Month Year

(b) In the Public service: _______/_______/_______

Day Month Year

11. ADDRESS:
(a) PERMANENT/HOME ADDRESS:__________________________________________________

_____________________________________________________

(b) CONTACT ADDRESS: _____________________________________________________

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 _____________________________________________________

(c) RESIDENTIAL ADDRESS: _____________________________________________________

_____________________________________________________

(d) E-MAIL ADDRESS: _____________________________________________________

(e) TELEPHONE NO(S): _____________________________________________________

a) Home b) Office c)GSM

SECTION C: INSTITUTIONS ATTENDED, COMPETENCIES & QUALIFICATIONS OBTAINED &

PROFESSIONAL AFFILIATIONS

12. INSTITUTIONS ATTENDED:

DATE
NAME OF INSTITUTION QUALIFICATION OBTAINED DATE OF AWARD
FROM TO

13. PhD. THESIS TITLE (If any):_____________________________________________________________________

14. AREA OF SPECIALIZATION (If any):__________________________________________________

SECTION D: EMPLOYMENT HISTORY

15. PREVIOUS EMPLOYMENT:

NAME AND ADDRESS OF DATE LAST POST LAST REASON FOR
ORGANISATION FROM TO HELD SALARY LEAVING

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SECTION E: DETAILS OF PRESENT EMPLOYMENT

16. STAFF CATEGORY: ACADEMIC SNR. ADMINISTRATIVE TECHNICAL SECRETARIAL JUNIOR

17. RANK (a) ON 1st APPOINTMENT:__________________________________________________

(b) ON CURRENT APPOINTMENT:_____________________________________________

18. DATE OF LAST PROMOTION: _______/_______/______

Day Month Year

19. CURRENT JOB TITLE: ____________________________________________________________

20. CURRENT SALARY: CONTISS/CONUASS STEP

21. DATE ON CURRENT SALARY LEVEL: ______/_____/____
Day Month Year

22. EMPLOYMENT STATUS: PERMANENT TEMPORARY CONTRACT SABBATICAL TERM

23. MEMBERSHIP OF PROFESSIONAL BODIES/SOCIETIES (Please List with dates):

i ____________________________________________________________________________

ii____________________________________________________________________________

iii____________________________________________________________________________

vi____________________________________________________________________________

24. USE OF COMPUTER:

(a) ARE YOU COMPUTER LITERATE? Yes/No

SECTION F: ADMINISTRATIVE, TEACHING, RESEARCH AND COMMUNITY SERVICE

RESPONSIBILITIES

25. LIST TEACHING RESPONSIBILITIES:

(a) Courses Taught

COURSE
COURSE TITLE CREDITS
CODE

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 TOTAL

(b) Students under Your Supervision

Undergraduate Masters PhD

Number

26. LIST RESEARCH ACTIVITIES: (PLEASE USE EXTRA SHEETS IF REQUIRED)

TOPIC STATUS * FUNDING VALUE (N) ABSTRACT

SOURCE
_________________________________ ____________ ___________ __________ _______________________

_________________________________ ____________ ___________ __________ _______________________

_________________________________ ____________ ___________ __________ _______________________

_________________________________ ____________ ___________ __________ _______________________

_________________________________ ____________ ___________ __________ _______________________

*INSERT NUMBERS AS FOLLOWS:
* 1. COMPELETED
2. IN PROGRESS

27. LIST COMMUNITY SERVICE RESPONSIBILITIES (If any):

i ____________________________________________________________________________

ii____________________________________________________________________________

iii____________________________________________________________________________
NUC/Staf/05
28. PUBLICATIONS: (PLEASE USE EXTRA SHEETS IF REQUIRED)

TITLE PUBLISHER DATE CATEGORY CODE * STATUS **

________________________ _____________________ __________ _____________________ ___________________

________________________ _____________________ __________ _____________________ ___________________

________________________ _____________________ __________ _____________________ ___________________

________________________ _____________________ __________ _____________________ ___________________

________________________ _____________________ __________ _____________________ ___________________

Insert numerals as follows:

* 1. BOOK 2. JOURNAL 3. CONFERENCE ** 1. PUBLISHED

4. MONOGRAPH 5. TECHNICAL REPORT 2. ACCEPTED FOR PUBLICATION
6. COMMISSIONED WORK

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29. RESEARCH BREAKTHROUGHS (If any):

_________________________________________________________________________________________

_________________________________________________________________________________________

____________________________________________________________________________________________

___________________________________________________________________________________________

SECTION G: ACCOMPLISHMENTS AT WORK

30. COMMUNITY SERVICE RENDERED:

PERIOD OF SERVICE
NATURE OF SERVICE BENEFICIARY
FROM TO

31. HOBBIES:_____________________________________________________________________

32. SIGNATURE AND DATE:

Signature: ________________________________________Date: _____/_____/________

33. NAME & SIGNATURE OF HEAD OF DEPARTMENT:

Name: ___________________________________________________________________

Signature: _______________________________________ Date: _____/_____/________

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 NUC/DAS/SSA/02
NATIONAL UNIVERSITIES COMMISSION

STUDENT INFORMATION Passport Photo

(Sections A-H to be completed by students)

SECTION A: INSTITUTIONAL INFORMATION

1. INSTITUTION:_______________________________________________________________

2. FACULTY:______________________________________________________________________

3. DEPARTMENT/UNIT:_____________________________________________________________

SECTION B: PERSONAL DATA

4. (a) MATRICULATION NUMBER:____________________________________

(b) JAMB REGISTRATION NUMBER: ________________________________

5. NAME: _________________________________________________________________________
SURNAME FIRST NAME MIDDLE NAME(S)

6. FORMER SURNAME (If any):_________________________________________________________

SURNAME FIRST NAME MIDDLE NAME(S)

7. SEX: 8. DATE OF BIRTH: _____/______/____ 9. NATIONALITY:_______________

M/F Day Month Year

10. STATE OF ORIGIN: _______________________________________________________________

11. (a) L.G.A.:_______________________ 11.(b) TRIBE: __________________________

12. Biometrics

Right thumb Right forefinger Left thumb Left forefinger

13. LANGUAGE(S) SPOKEN:____________________________________________________________

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14. MARITAL STATUS: S SINGLE; M MARRIED; D DIVORCED; W WIDOW(ER)
(ENTER APPROPRIATE LETTER)

15. RELIGION: C CHRISTIANITY; I ISLAM; T TRADITIONAL; O OTHERS

(ENTER APPROPRIATE LETTER)

16. IF Others in 15, then

Specify:_______________________________________________________

17. HEALTH STATUS: NORMAL PHYSICALLY CHALLENGED

18. IF PHYSICALLY CHALLENGED, PLEASE STATE TYPE:____________________________________

19. IF SPECIAL MEDICATION OR THERAPY IS REQUIRED, PLEASE SPECIFY:____________________

_____________________________________________________________________________

21. PREVIOUS EDUCATION:

DATE
NAME OF INSTITUTION QUALIFICATION OBTAINED DATE OF AWARD
FROM TO

22. USE OF COMPUTERS:

ARE YOU COMPUTER LITERATE? Yes/No _______________________________________________________

23. PERSON(S) TO CONTACT IN CASE OF EMERGENCY:

(a) NAME:________________________________________________________

ADDRESS:________________________________________________________

RELATIONSHIP:________________________________________________________

TELEPHONE: ________________________________________________________

E-MAIL:______________________________________________________

(b) NAME:________________________________________________________

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 ADDRESS:_________________________________________________________

RELATIONSHIP:________________________________________________________

TELEPHONE: ________________________________________________________

E-MAIL:______________________________________________________

SECTION C: ACADEMIC PROGRAMME

24. PROGRAMME STATUS: UNDERGRADUATE POSTGRADUATE

25. PROGRAMME TYPE: FULL TIME PART TIME OPEN & DISTANCE LEARNING SANDWICH

LANGUAGE IMMERSION SEMESTER

26. ACADEMIC PROGRAMME OF STUDY:___________________________________________

27. ACADEMIC QUALIFICATION IN VIEW: __________________________________________

28. STANDARD DURATION OF ACADEMIC PROGRAMME: _______________________________

29. YOUR PRESENT LEVEL IN ACADEMIC PROGRAMME:

(TICK ONE) 100 LEVEL 200 LEVEL 300 LEVEL 400 LEVEL 500 LEVEL

SUB-DEG PG-DIP MASTERS PhD

30. TOTAL FEES PAID/PAYABLE THIS SESSION: N _________________________________________

31. SPONSORSHIP: PARENTS/ GUARDIAN GOVERNMENT OTHER(S)

32. YEAR OF ENTRY TO THE UNIVERSITY: _______________

33. MODE OF ENTRY: REMEDIAL UME DIRECT ENTRY T RANSFER

34. IF TRANSFER, GIVE NAME OF PREVIOUS UNIVERSITY;_____________________________

SECTION D: QUALIFICATIONS AND MODE OF ENTRY

35. ENTRY QUALIFICATION:

36. YEAR OBTAINED: ____________

a) O Levels

b) A Levels: IJMB GCE

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 c) Other(s): NCE ND HND

37 HOW MANY SITTINGS: 1 2

38. DETAILS OF O LEVEL RESULTS:

1ST Sitting
SUBJECT TITLE GRADE REMARKS

2ND Sitting
SUBJECT TITLE GRADE REMARKS

39. UNIVERSITY MATRICULATION EXAMINATION RESULTS (UTME):

SUBJECT TITLE SCORE

English
Mathematics

TOTAL SCORES OBTAINED

40. INTERIM JOINT MATRICULATION BOARD EXAMINATION RESULTS:

SUBJECT TITLE GRADE

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41. GCE/ A LEVEL:

SUBJECT TITLE GRADE

SECTION E: EXTRA-CURRICULAR ACTIVITIES

42. LIST SPORTING ACTIVITIES:

i) ________________________________________________________________________

ii) ________________________________________________________________________

iii) ________________________________________________________________________

43. LIST MEMBERSHIP OF REGISTERED CLUB(S):

i) ________________________________________________________________________

ii) ________________________________________________________________________

44. PRESENT POST(S) IN CLUB(S): __________________________________________________

45. POST(S) HELD IN PREVIOUS CLUB(S):_____________________________________________

46. STUDENT UNION ACTIVITIES AND POST(S) HELD WITH DATES:________________________

___________________________________________________________________________

47. LIST OTHER EXTRA-CURRICULAR ACTIVITIES:

i) ________________________________________________________________________

ii) ________________________________________________________________________

iii) ________________________________________________________________________

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SECTION F: AWARDS

48. PRIZES/AWARDS RECEIVED:

S/N NAME OF AWARD DATE

SECTION G: CHANGE OF DEPARTMENT

49. PREVIOUS ACADEMIC PROGRAMME (If any):______________________________________

50. REASONS FOR CHANGE:_____________________________________________________

_________________________________________________________________________

51. SIGNATURE AND DATE

Signature:__________________________________________Date:_______/_____/___ _

52. NAME AND SIGNATURE OF DEAN/HEAD OF DEPARTMENT (Please Specify):

Name: ___________________________________________________________________

Signature:__________________________________________Date:_______/_____/___ _

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