(OU/Exam/1A)

Open University of Mauritius

Tel: (230) 403 8200

Fax: (230) 464 8854

Rduit, Mauritius
Website: www.open.ac.mu

Email: openuniversity@open.ac.mu

EXAMINATION ENTRY FORM

Academic Year : ...........

Semester :

Programme/Course : ...
...
Year/Cohort : ...
..
Name of Learner : ........
..
........

Address : ..
....................

Learner ID No. : .
MODULES TO BE EXAMINED
Module Code

Module Title

I confirm that I will sit for _________ (number) modules for the above programme.
..
..
Signature of Learner

Date

Any learner with ill-health or physical challenges (certified by a registered medical practitioner or any
other relevant authorities) should inform the Director-General, Open University of Mauritius to make
special arrangements.