Kyambogo University Application Forms for Under Graduate Students

APPLICATION FORM FOR ADMISSION TO THE UNIVERSITY
UNDER THE PRIVATE SPONSORSHIP SCHEME
“TO BE COMPLETED BY A’ & O’ LEVEL HOLDER APPLICANTS ONLY”
TO BE COMPLETED BY A’ LEVEL APPLICANTS ONLY
ACADEMIC YEAR FOR WHICH ADMISSION IS SOUGHT: (e.g. 2010/2011) .........................................................................
NOTE: This form must be submitted with evidence of payment of application fees (Receipt and Bank slip).
PART I
ALL NAMES MUST BE WRITTEN IN FULL (NO INITIALS) AND THE FORM SHOULD BE FILLED IN CAPITALS
1 (a) Surname (in full) ........................................................................................................................................................
(b) Other names (in full) ........................................................................(c) Gender: (Tick) Male Female
(d) Date of Birth ................................................................................... (e) Age ............................................................
(You must attach a copy of the Birth Certificate)
(f) Home District ................................................................................. (g) Citizenship .................................................
(h) Any disability ................................................................................. (provide full size photograph depicting the
disability where possible)
2 (a) Programmes applied for:
Choices of Programmes at Kyambogo University – Up to 6 choices (use the three letter codes provided)
1ST
2ND
3RD
4TH
5TH
6TH
Passport
Photograph
Right hand
Thumb print
(b) Subject combinations for B.A. (Arts): B.A. (Social Sciences), B.A. (Education) and B.Sc. (Education) only (Use the letter codes provided)
3. Uganda Certificate of Education (UCE) or its equivalent. Index No:.......................................................................
Year of Examination:.....................................................
SUMMARY OF GRADES
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................................
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).
PART II
5. 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) E-mail .......................................................................................................................................................................
(h) Religious affiliation (if any) ......................................................................................................................................
6. Home County: ..........................................................................................................................................................
SUBJECT
GRADE
7. Information on parents:
Father Mother
(a) Surname:....................................................................... .....................................................................
(b) Other names:................................................................. ....................................................................
(c) Village of Birth: ............................................................ ....................................................................
(d) Sub-county: .................................................................. ....................................................................
(e) District of Birth .......................................................... ....................................................................
(f) Nationality................................................................. ....................................................................
(g) Address ...................................................................... ....................................................................
8. Information on Guardian (Where applicable)
Guardian’s Name............................................. Guardian’s occupation...........................................
Guardian’s Address........................................ Telephone No. ........................................................
9. Give 1 name of person in responsible positions from whom confidential information may be obtained
about you if necessary
(a) Name: .............................................................................................................................................
Address: ........................................................................................................................................
Telephone Number: .......................................................................................................................
10. 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.
It should be NOTED by all applicants that cases of impersonation, Falsification of documents or giving false / incomplete information wherever discovered either at Registration or afterwards will lead to automatic CANCELLATION of Admission and prosecution in the Uganda Courts of Law.
Signature of the applicant: ....................................................................... Date: ......................................

***Please not this form is not accurate