AMIS MEMBERSHIP REGISTRATION FORM

Category Selection

State Chapter*

Listing Type*

School Location and Basic Information

School Location:

LGA:

Ward:

School Level:

School Name (As registered by CAC):

CAC Registration Number:

School contact information:

Physical address:

Phone Numbers:

WhatsApp Numbers:

Email Address:

Social Media Handles:

Date School was Established (Month / Year):

Date School Joined AMIS (Month / Year):

School AMIS Registration Number:

Proprietorship Type:

Sole Proprietor

Partnership

Sole proprietor's detail (if Sole Proprietorship)

Name:

Gender:

Age:

21-30

31-40

41-50

51-60

61-70

Over 70

Phone Number:

WhatsApp Numbers:

Email Address:

Partnership Details (if Partnership)

Contact Person's Detail:

Name:

Gender:

Age:

21-30

31-40

41-50

51-60

61-70

Over 70

Phone Number:

WhatsApp Numbers

Email Address:

Co-owners / Partners

i.

Name:

Phone Number:

WhatsApp Number:

Email Address:

ii.

Name:

Phone Number:

WhatsApp Number:

Email Address:

iii.

Name:

Phone Number:

WhatsApp Number:

Email Address:

Head of School's detail

Name:

Gender:

Age:

21-30

31-40

41-50

51-60

61-70

Over 70

Qualification(s):

Phone Number:

WhatsApp Number:

Email Address:

Staffing

DESCRIPTION	MALE	FEMALE	TOTAL
Management
Teaching
Non-Teaching
TOTAL

Enrollment

NUR/PRY or BASIC

DESCRIPTION	MALE	FEMALE	TOTAL
Creche
Pre-Nursery
Nursery
Basic 1-3
Basic 4-6
Basic 7-9
TOTAL

SECONDARY SCHOOL

DESCRIPTION	MALE	FEMALE	TOTAL
JSS 1-3 (Basic 7-9)
SSS 1-3
TOTAL

Awards / Recognition

List awards:

Any other information

School Images

School Logo

School Images

Account Creation

Username:

Password:

Confirm Password:

Terms and Conditions

I agree to the terms and conditions*