Makerere University Application (Admissions) form for Private Students

APPLICATION FORM TO THE UNIVERSITY UNDER THE

PRIVATE SPONSORSHIP SCHEME

2010/2011 ADMISSION

Current

Right

Passport

hand

NB:  TO BE COMPLETED BY A' LEVEL LEAVERS ONLY

Photograph

Thumb

print

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

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

PART I

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

ALL NAMES MUST BE WRITTEN IN FULL (NO INITIALS)

1

(a)

Surname (in full) ..................................................................................................................................................................

(b)

Other Names (in full)  …………………………………………………………………………………………………….

(c)

Male

Female

(d)

Date of Birth ( DD...............MM..................YY..................)

(e)

Citizenship.............................................................

(You must attach a copy of the birth certificate)

(f)

Home District .......................................................................

2

(a)

PROGRAMMES APPLIED FOR

Choices of Programmes at the University - up to 6 choices (use the three letter codes provided at appendix A)

1ST

2ND

3RD

4TH

5TH

6TH

(b)

Choices of BA or BSC subject combinations (use the numerical codes provided)

3

Uganda Certificate of Education (UCE) or its equivalent. Index No....................................................Year of Examination......................................................

SUBJECT

SUMMARY OF GRADES

Distinctions

Credits

GRADE

You must attach a photocopy of the Uganda Certificate of Education or its equivalent

4

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

Please indicate the subjects and grades where applicable.

1

2

3

4

5

SUBJECT

GRADE

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

5

If you are already admitted to the University indicate;

(i) Registration Number..........................................................

(ii) Programme............................................................................

(iii) Sponsor................................................................................

PART II

6

Other Personal Information

(a)

Marital Status (married , single , others 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)...........................................................................

7

(a)

Home County....................................................................................................

8

Information on Parents

Father

Mother

Surname……......................................................................................................................

........................................................................................................................

Other Names......................................................................................................................

........................................................................................................................

Date of Birth.......................................................................................................................

........................................................................................................................

Village of Birth...................................................................................................................

........................................................................................................................

Sub-County.........................................................................................................................

........................................................................................................................

District of Birth...................................................................................................................

........................................................................................................................

Nationality….....................................................................................................................

........................................................................................................................

Country of Residence.......................................................................................................

........................................................................................................................

Address................................................................................................................................

........................................................................................................................

9

Information on Guardian (where applicable)

(n)

Guardian's name................................................

(o)

Guardian's occupation............................................................................

(p)

Guardian's address..........................................

(q)

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

10

Responsibilities held while at School / College

11

Employment Record

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

EMPLOYER

POST(S) HELD

DATE(S)

12

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

if necessary.

(i)

Name.............................................................

Address.........................................................

Telephone Number .........................................

(ii)

Name.............................................................

Address.........................................................

Telephone Number .........................................

13

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.

14

It should be NOTED by all applicants that cases of Impersonation, Falsification of Documents or giving False /Incomplete

Information wherever discovered either at Registration of afterwards will lead to automatic CANCELLATION of Admission

and prosecution in the Uganda Courts of Law.

Signature of the applicant .....................................................

Date  .....................................

Please not that this form is not accurate due to the lay out of this site, you can get a better one from Makerere University