P.O.

Box 20000,
Admissions Of ce Kampala - Uganda (EA)
Email: admissions@kiu.ac.ug

Application Number: 222250

Title Mr Country Uganda

Surname Francis District/Province/State Kitgum District

Other Names Nokrach Parent/Guardian/Next of Kin Also Rose

Phone +256783423437 Relationship Aunty

Email nokrachfrancis441@gmail.com Next of Kin's Phone 0772970929

PERSONAL INFORMATION
Gender Male Date of Birth 24th July, 1996

Nationality Ugandan Identi cation National ID (CM96085100YEAE)

PROGRAM INFORMATION
Course Applied For Diploma in Nursing Sciences (Extension) Campus Western Campus

Second Choice Diploma in Medical Radiography Session 2022/2023

Third Choice Diploma in Clinical Medicine and Community Health Intake August

DISABILITIES

None Hearing Mobility Sight

ATTESTATION
I hereby certify that the information given in this application is correct and complete and to the best of my knowledge, and hereby give my
permission to the Admissions Committee to obtain any veri cation deemed necessary to process my application.

I further certify that I will arrange for the forwarding of of cial transcripts as requested in the instructions and that such transcripts become the
property of the University and will not be forwarded to another institution nor returned to me.

I will include with this application my application fee and other documents as required in the application instructions including: essays,
recommendations, test scores and nancial guarantee.

Do You Agree to the Attestation? Yes Date 5th Apr, 2023 8:09 am