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  • Catholic University of Central Africa

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    Gaelle Mbang
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    This document is a registration form for the Catholic University of Central Africa. It collects identification information about the student such as name, date of birth, nationality, religion, and contact details. It also requests information about the student's admission such as the faculty, level, cycle and option chosen as well as their fee status and any scholarships. Finally, it provides spaces to record validation of payments made by the student for registration, associations, medical checks, health insurance and tuition installments.

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    Registration Form

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    This document is a registration form for the Catholic University of Central Africa. It collects identification information about the student such as name, date of birth, nationality, religion, and contact details. It also requests information about the student's admission such as the faculty, level, cycle and option chosen as well as their fee status and any scholarships. Finally, it provides spaces to record validation of payments made by the student for registration, associations, medical checks, health insurance and tuition installments.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    2 views2 pages

    Catholic University of Central Africa

    Uploaded by

    Gaelle Mbang
    This document is a registration form for the Catholic University of Central Africa. It collects identification information about the student such as name, date of birth, nationality, religion, and contact details. It also requests information about the student's admission such as the faculty, level, cycle and option chosen as well as their fee status and any scholarships. Finally, it provides spaces to record validation of payments made by the student for registration, associations, medical checks, health insurance and tuition installments.

    Copyright:

    © All Rights Reserved
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    of 2

    CATHOLIC UNIVERSITY OF CENTRAL AFRICA

    Catholic Institute of Yaoundé


    BP 11628 Yaoundé, Cameroon-Tel: 22 23 74 00/01, 22 30 54 98/99-Fax: 222 23 74 02, 222 30 50 01
    Courriel: sau@ucua-icy.net, rectorat@ucac-icy.net/site web: www.ucuac-icy.net
    REGISTRATION FORM Student Matricule
    Number
    20……../20………
    I. IDENTIFICATION OF STUDENT
    Status: Priest Religious Seminarian Lay Mrs Miss Mr
    Name: ____________________________________ Surname: ___________________________________
    Date of birth: _____________/________/_________ Nationality: __________________________________
    Religion: _________________________________Email: _________________________________________
    Diocese or Congregation (For priests and religious): _____________________________________________
    Employer: (For workers) ___________________________________________________________________
    External: mini-city/street ________________________________ Internal: Room No ____________________
    Tel.: Student ________________________________Parent/Sponsor
    __________________________________
    II. ADMISSION
    Faculty: __________ Level: ____________ Cycle: __________________Option:
    ________________________
    Regular Adjourned Regular with re-sits Adjourned with re-sits Repeater
    Repeater with re-sits
    Fee: _______________ Scholarship: Yes No Nature:
    ___________________________________
    Last class attended: _________________________________________________________________________
    ___________________________________
    Signature of Dean/Director
    III. INDEMNIFICATION
    SCHOLARSHIP Yes No Nature ___________________________________________________________
    Date of medical check-up: ______/_____________/20________________________ Code _______________
    IV. VALIDATION OF PAYMENTS (Administration Only)
    DESCRIPTION AMOUNT DATE VISA PENALTIES
    Registration (non-refundable) _______________CFA --/--/20-- Registration
    Students’ Associations 5000 --/--/20--
    Medical check-up 4000/3.500 --/--/20-- ____________
    Health Insurance 29.850 --/--/20--
    1st payment ________________ --/--/20-- 1st installment
    2nd payment _________________ --/--/20-- ____________
    3 payment
    rd
    ________________ --/--/20--
    4th payment ________________ --/--/20-- 2nd installment
    NB: This form must be returned to the Registrar’s secretariat immediately after validation at the bursary.

    Any student who wishes to be reimbursed can only receive partial reimbursement after the Dean’s/Director’s signature.

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