COMPREHENSIVE INSTITUTE

P.O BOX 2871 Kampala Tel: 0414-233294/232856

E-mail: info@yci.ac.ug

Website: www.yci.ac.ug

“SEEK KNOWLEDGE FROM CRADLE TO GRAVE”

APPLICATION FORM

Applicant’s Personal Details:

Surname:………………………………Other Names: ……………………Date: ………………

(Names should be those that appear on your academic documents)

Date of Birth: ………………………Gender: Male Female Nationality: ………………

Physical Address: ………………………Telephone No: 1) …………………….…………………

2) ………………………………………

Courses Applied For: Diploma Certificate Elementary

(Fill in the courses you to study in order of your preference)

CHOICE NAME OF COURSE APPLIED FOR STUDY SESSION (Morning,

Afternoon, Evening, Distance)
According to the available session
1st Choice
2nd Choice
3rd Choice
Educational Background of the Applicant:
(Primary schools, Secondary schools, Colleges and Universities attended)

NAME OF SCHOOLS ATTENDED YEAR OF STUDY QUALIFICATION OBTAINED

FROM TO (PLE, UCE, UACE, CERTIFICATE) etc
Details of Guardian/Parent/Sponsor:

(Give Details of person to contacts/ Next of Kin/ Sponsor)

Name: ………………….………Relationship: ……………………Occupation: ………….……

Physical Address: ………………………Telephone No: ……………………Signature: …….…

Note:

This form should be returned immediately after filling.

It is your responsibility not to give false document (s) or incomplete information in support of
this application. False information may lead to automatic cancellation or discontinuation if
discovered at nay future date.

Signature of Applicant: …………………………………Date: ………………

For official use only

Admission Committee’s Recommendation:

The Applicant is Admitted: Rejected: Pending:

Remarks: …………………………………………………………………………….……………

Registration Number: ………………………………… Student Number: ………….……………

Official Signature: ……………………………………. Date: ……………………………………