Makerere University Application Form for Diploma Holders- Admissions

 

APPLICATION FOR ADMISSION TO THE UNIVERSITY (UP-COUNTRY CENTRES)

UNDER THE PRIVATE SPONSORSHIP SCHEME

Current

Right Hand

2010/2011 ADMISSIONS

Passport

Thumb Print

TO BE COMPLETED BY DIPLOMA HOLDERS

Photograph

ACADEMIC YEAR FOR WHICH ADMISSION IS SOUGHT e.g 2010/2011 ……………………

NOTE: (i)  This form must be submitted with evidence of payment of application fee.

(ii)  To be completed by applicants who are seeking admission on the basis of

a Diploma only.

PART I

ALL NAMES MUST BE WRITTEN IN FULL (NO INITIALS) AND THE FORM SHOULD BE FILLED IN CAPITAL LETTERS

1

(a)

Surname (in full)  ………………………………………………………………………………………………………

(b)

Other names (in full)

..…………………………………………………………………………………………….

(c)

Sex: (Tick)

Male

Female

(d)

Date of Birth (DD………………….

MM…………….  YY……………)    (e)  Citizenship/Nationality …………………………

(You must attach a copy of the birth certificate)

(f)

Home District …………………………………………………………………….

2

(a)

PROGRAMME APPLIED FOR

Use the three letter codes provided in the announcement

CHOICE (ONE)

CHOICE (TWO)

3

Uganda Certificate of Education (UCE) or its equivalent

Index No ……………………………………

Year of Examination………………….

SUMMARY OF GRADES

SUBJECT

DISTINCTIONS      CREDITS     PASSES

GRADE

 4.    Uganda Advanced Certificate of  Education (UACE) or its equivalent. Index No. ………………… Year of Examination……....................

        Please indicate the subjects and grades where applicable.

 

          SUBJECT

 

          GRADE

        Attach a photocopy of the UACE Certificate or its equivalent (Strictly a photocopy of the Certificate or results slip must be attached).

5.                                            Institutions attended, if any

 

                   YEAR                                              Name of Institution                            Qualification Obtained      Class of Award (If any)

 

From                  To

Attach certified copies of Certificates and Academic Transcripts of Diplomas from the awarding institutions.

6.        If you are already admitted to the University indicate;

(i)            Registration Number  ………………………………

(ii)          Programme admitted to ……………………………

(iii)        Sponsor ………………………………………………

PART II

7.        Other Personal Information

(a)       Marital Status (Married, Single, Other specify)  ……………………………………………………………………………………………

(b)       Permanent Address  …………………………………………………………………………………………………………………………...

(c)        Emergency Contact address, if different from (b) above  …………………………………………………………………………………

(d)       Telephone No …………………………………….. (e)          Fax No ……………………………..  (f)  E-mail  …………………………

(g)       Religious affiliation (if any)  ……………………………………………………………………..

8.     (a)       Home County………………………………………………….             (b)   Sub-County (LC III)  ………………………………………

        (c )      Parish (LC II)  …………………………………………………               (d)   Village (LC I)  ………………………………………………

9.     Information on Parents

Father                                                                                                                    Mother

(a)       Surname  …………………………………………………….                 …………………………………………………………………….

(b)       Other Names  ……………………………………………….                 ……………………………………………………………………

(c )       Date of Birth  ………………………………………………..                 ……………………………………………………………………

(d)       Village of Birth  …………………………………………….                 ……………………………………………………………………

(e)       Sub-County  …………………………………………………                                ……………………………………………………………………

(f)        District of Birth  …………………………………………….                 ……………………………………………………………………

(g)       Nationality  …………………………………………………                 ……………………………………………………………………

(h)       Address  ……………………………………………………..                 ……………………………………………………………………

10.   Information on the Guardian (where applicable)

        (i)            Guardian’s Name  ………………………………………….  (j)        Guardian’s Occupation …………………………………

(k)           Guardian’s address  ………………………………………..  (l)        Telephone Number ……………………………………..

11.   Positions of responsibility held while at School/College

        ………………………………………………………………………………

        ……………………………………………………………………………...

        ……………………………………………………………………………...

12.     Employment Record

Give brief details of employment record. You may use a separate sheet of paper

 

            EMPLOYER                                                          POST(S) HELD                                                                    DATES

13.   Give names of 2 persons in responsible positions from whom confidential information may be obtained about you.

        (i)            Name  ………………………………………………………………

                        Address  ……………………………………………………………

                        Telephone Number  ……………………………………………...

        (ii)           Name  ………………………………………………………………

                        Address  ……………………………………………………………

                        Telephone Number  ……………………………………………...

14.   It should be NOTED by all applicants that cases of impersonation, Falsification of Documents or giving false/incomplete information whenever discovered either at Registration or afterwards will lead to automatic CANCELLATION of Admission and prosecution in the Uganda Courts of Law.

15.     Declaration by the Applicant

I have noted and understood the implication of giving incorrect information. I confirm that the information given on this form, to the best of my knowledge is correct.

Signature of Applicant  …………………………………………………..       Date  ………………………………………………………

Please not that this application is not accurate, you can get the more accurate one from Makerere University