UNIVERSITY OF DSCHANG REPUBLIC OF CAMEROON

Po. Box: 96 Dschang - Cameroon Peace – Work – Fatherland

Tel.: (237) 233 45 10 92 REPUBLIQUE DU CAMEROUN
Tel. /Fax: (237) 233 45 13 81 Paix – Travail – Patrie
Email: udsrectorat@univ-dschang.org
Website: www.univ-dschang.org
Facebook page: Université de Dschang
Twitter: @Univ_Dschang
Registration: http://sigesonline.univ-dschang.org Glue or staple
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DIRECTORATE OF STUDENTS' WELFARE 4x4
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DIVISION OF SPORTS AND RECREATION PHOTO
(obligatory)

ACADEMIC YEAR _________/__________

SPORTS AND CULTURAL ACTIVITIES FORM

All new students will fill this form and submit personally in any office of the
Division of Sports and Recreation (DASA) or in any sport and culture office in external Campuses
Like these Facebook pages : Université de Dschang – Sports AND Université de Dschang – Culture
and register to Facebook group : UNIVERSITÉ DE DSCHANG – SPORTS & CULTURE

PERSONAL INFORMATIONS (Obligatory)

Name and Surname: _____________________________________________ Gender ____ Height ________Weight____

(M / F)
Date and place of birth: ___________________________________________________________ Married Single
E-Mail: _________________________@_______________ Tel : ______________/______________ WhatsApp : __________
School (Faculty): __________________ Subject: __________________________________________________ Level ____
Former School or Institution: _______________________________________________________ Town ______________
(Or place of work for workers)
Do you have any particular disease or handicap? Yes No If Yes, please precise _____________________

FILL THE TWO CATEGORIES IF YOU CAN – I. SPORTS ACTIVITIES, II. CULTURAL ACTIVITIES

I. SPORTS ACTIVITIES
Among the Sport Disciplines listed below, which do you practice ?
Athletics (Running, Throwing, Jumping), Basketball, Football, Handball, Gymnastic, Judo, Wrestling, Paralympics Sports, Tennis, Table Tennis, Volleyball

1st choice : ______________________ 2nd choice : ______________________ Other (Precise) : ______________________

Level of practice : Scholastic Civilian (in which club?)_____________________________ Are you a referee? Yes No
Competitions (FENASSCO, DIXIADES, CHAMPIONSHIP…) _____________________________________________________
Awards ______________________________________________________________ National team ? Years ______
Which other skill or extra talent do you possess? (Example: creativity, healing, informatics genius…) ______________________
II. CULTURAL ACTIVITIES
Among the Cultural Activities listed below, which do you practice ?
Drawing, Painting, Decorative arts, Singing, Choir, Traditional dances, Ballroom Dances, Freestyle dance, Freestyle foot, Short story,
Poetry, Music, Photography, Theatre, Stand-up, Traditional culinary arts, Poetry recitation, Story-telling, Slam, Miss, Mister, Fan's club

1st choice : ______________________ 2nd choice : ______________________ Other (Precise) : ______________________

Level of practice : Scholastic Civilian (in which group ?) ____________________________________________________
Competitions or prestations (KERMES, SPECTACLES, UNIFAC…) _____________________________________________
Awards _________________________________________________________________________________________
Which other skill or extra talent do you possess? (Example: creativity, healing, informatics genius…) _____________________
III. ASSOCIATIVE LIFE (CULTURAL CLUBS OF THE UNIVERSITY OF DSCHANG) (optional)
Decorative arts, Photography, Fine arts, CEMAC, Choir, Commonwealth, Red cross, Ballroom dances, Traditional dances, Debate and
leadership, Human rights and integrity, Written and Oral Literature, Civic education and national integration, Entrepreneurship, Fanfare,
Fan's Club, Francophonie, Handicap, Hygiene and sanitation, Informatics and promotion of digital literacy, Majorettes, Orchestra,
Olympics and ethics, Health - STI/HIV and fight against drug use, Theatre, Tourism and friends of the nature.
Among the Clubs listed above, which one can you solicit ?
1st choice : _________________________________________ 2nd choice : ________________________________________
Observations of the DASA