Applicant’s

Form “D” Photograph

GULU UNIVERSITY
P.O. Box 166 Tel: +256-471-432921
Gulu, Uganda Email: ar@gu.ac.ug
URL: www.gu.ac.ug

OFFICE OF THE ACADEMIC REGISTRAR

APPLICATION FORM FOR UNDERGRADUATE DEGREE, DIPLOMA OR CERTIFICATE PROGRAMMES

PRIVATE SPONSORSHIP

(APPLICATION FOR ADMISSION USING “A” LEVEL, “O” LEVEL CERTIFICATES OR OTHER CERTIFICATES)

1. Academic Year ……………………………………………………………………………………………………

2. Programmes applied for: Use the 3 letter Codes for programmes shown in the list.

1st Choice 2nd Choice 3rd Choice 4th Choice

3. a) Surname (Block letters)……………………………………………………………………………………..

b) Other Names (in full)…………………………………………………………………………………………

c) Sex [ ] Female [ ] Male. (Tick as applicable)

4. a) Date of birth [day, month, year] ………/………/……………

b) Place of Birth …………………………………………………………………………………………………

5. Home District: ……………………………….. Sub-county…………………………………………................

6. Citizenship: …………………………………….. Country of Residence: ……………………………………...

7. Religious Affiliation………………………………………………………………………………………………...

8. a) Marital Status………………………. b) Number of Children…………………………………………..

9. Permanent Address ………………………………………………………………………………………………

………………………………………………………………………………………………………………………

Telephone Number …………………………………… Fax Number ……………………….…………………

10. Contact Address: (if different from 9) ………………………………………………………….......................

……………………………………………………………………………………………………………………….

11. UGANDA CERTIFICATE OF EDUCATION (U.C.E) OR ITS EQUIVALENT:

a) Index Number ……………………………………………………………………

b) Centre Name ……………………………………………………………………
c) Year of Examination ……………………………………………………………………
d) Number of Distinctions ……………………………………………………………………
e) Number of Credits ……………………………………………………………………
f) Number of Passes ……………………………………………………………………
PLEASE ATTACH A PHOTOCOPY OF YOUR U.C.E. RESULTS OR ITS EQUIVALENT.

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12. UGANDA ADVANCED CERTIFICATE OF EDUCATION (U.A.C.E) OR ITS EQUIVALENT:
a) Index Number ……………………………………………………………………
b) Name of School/Institution (Centre) ……………………………………………………………………
c) Year of Examination ……………………………………………………………………

Subject Grade

…………………………………………………………….. ………………………………………..
…………………………………………………………….. ………………………………………..
…………………………………………………………….. ………………………………………..
…………………………………………………………….. ………………………………………..
General Paper … … … … … ………………………………………..

PLEASE ATTACH A PHOTOCOPY OF THE UGANDA ADVANCED CERTIFICATE OF EDUCATION OR ITS

EQUIVALENT. (STRICTLY A COPY OF CERTIFICATES OR RESULT-SLIP MUST BE ATTACHED.)

13. OTHER CERTIFICATE(S) OBTAINED:

Institution Attended Qualifications Obtained Date

…………………………………………………… …………………………….. ……………………
…………………………………………………… …………………………….. ……………………

PLEASE ATTACH A PHOTOCOPY OF EACH CERTIFICATE.

14. SPONSORSHIP:

Name of the Sponsor……………………………………………………………………………………………...

Address: ……………………………………………………………………………………………………………

……………………………………………………………………………………………………………………….

Tel No………………………………………… Fax No. ………………………………………………………….

Sponsor’s Signature ……………………………………. Date ………………………………….

15. DECLARATION:

I declare that the information given on this form is correct and accurate.

Signature of Applicant ………………………………….. Date …………………………………

NB: Please attach the original receipt and bank slip as evidence of payment of the application fee.
Make sure you photocopy Page 1 of this Application Form, which may later be produced by
successful candidates before issuing Admission Letter.

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