4304 UGANDA CHRISTIAN UNIVERSITY A Centre of Excellence in the Heart of Africa Attach, current P.O. Box 4, Mukono,Uganda passport-sized Tol:(Of) 4256 312.950 880 photograph here (Mob) +256 794770 826 E-mail: admissions@ucu.ac.ug Website: www.ucu.ac.ug OFFICE OF THE DEPUTY VICE CHANCELLOR FOR ACADEMIC AFFAIRS PN Wor Nilo Rae oe CoD aac UU Ua ele ar W ce mG) NOTE: Transcript copes ofboth 0"level and ‘4’leve esl slip/ Cerificate, other qualifications and birt certificate shouldbe attache fo this form. All academic records it a language other than English must be accompanied bya certified English translation. At registration, originals shall Be required Inia he selection lete for asson for those who quaifyis provisional. I¢ doesnot give the applicant am entidement to place at the Universi It 1s subject to confirmation according tothe instructions Seti PLEASE FILL THIS FORM IN CAPITAL LETTERS CHOICE OF INTAKE (Indicate it January, May, September Intake) eer dames ca uunass Indicate your preterence, specifying whether for Day, Evening or Modular DEGREE PROGRAMMES Day/Evening/Modular 1% Choice (e.g. Bachelor of Laws) 2nd Choice Day/Evening/Modular — sera DIPLOMA PROGRAMMES, _ | 1° Choice | 2° Choice CHOICE OF CAMPUS/COLLEGE (Please tick only one) 1" Choice 2" Choice (1 Main Campus (Mukono) Main Campus (Mukono) C Kampala Campus Co Kampala Campus - 1 Bishop Barham University College (Kabale) © Bishop Barham University College (Kabale) ( Mbale Campus ( Mbale Campus Ci Arua Campus Cl Arua Campus 1 Other Specify Other Specify ge | qe |pa SECTION 1.0: APPLICANT'S PERSONAL INFORMATION Name: ‘Sumame: (use name on academic documents) | Other Name: Tite: (Rev., Dr, Mr, Miss, Mrs.) ‘Gender: [ Male: Female: Date of Binh: DD: Ti WY! Nationality: ‘Country of Residence: ‘Home District ‘Home Diocese Religious affllaion: (i Ghrisian, State Denomination Marital Status: | Single: ‘Married (atach Marriage Cerificate) (Others specify: “Type of marriage: "Name of spouse: ‘Number of children: Do you have any disabity? Yes [_]No [7] tyes, state the type of aby. conic ness Physical oisbity [1 Impairment (Hearing, Speaking, Seeing, etc) D others Brietly state nature of disabilty Pe rater sk x on LCL P.O, Box Town: Postal Contact: ‘Country Telephone: [Email 4.3: PARENTS/GUARDIANS INFORMATION Give details of Parents, Guardian and where applicable the sponsor FatheriLegal Guardian Mother/Legal Guardian ‘Sponsor (if applicable) Name P.O. Box Town Telephone Email ea asus) Give one name of a person in a responsible position from whom confidential information may be obtained about you if necessary. Name: Nationality: Postal contact: P.O. Box Town: Country Telephone: Email:SECTION 2.0: EDUCATION BACKGROUND 2.0 Secondary Schools/Colleges/Special training taken (Give names, dates and qualifications ) Name and address of school / Institution From To Qualification 2.1 Mature Age: Year .. Index No, 2.2, Are you presently engaged in other academic studies? Yes No 2.3. If Yes, which course are you pursuing?...... 2.4. If you have been involved in sports activities, kindly list and attach your sports certificates... 25. SECTION 3.0: EMPLOYMENT RECORD Name and address of employer Designation From To (To be completed by an ordained Pastor or Priest or any other eminent Religious Leader). 4.1. Applicants for Ordination should attach copies of their Baptism and Confirmation Certificates 4.2. _ The Diocesan Bishop’s recommendation and verification of the suitability of the Ordinand for the programme,