Apply Online A. Personal Information Date of Birth E-mail Gender ---MaleFemale Marital Satus ---SingleMarried Personal Tel: Home District Nearest Home Town Village/Zone District NB: If Married please attach copy of the Marriage Certificate B. Parent/Guardian Information Title ---DrMrMrsMiss Name of Parent/Guardian Tel. Contact C. Sponsoring Organization (if any) Name of the Organization: Address: E-mail Tel. Contact NB: A letter addressed to the principal confirming sponsorship by the organization should be written to accompany the application form D. Programme/ Course Choice select the course and indicate either Certificate or Diploma. 1st Choice Certificate/Diploma ---CertificateDiploma 2nd Choice Certificate/Diploma ---CertificateDiploma 3rd Choice Certificate/Diploma ---CertificateDiploma D. Applicant Academic Exposure i. Primary Living Examination Certificate School Year Address Index No: Subject English Mathematics Science Social studies ii. Uganda Certificate Education (O'Level) School Year Address Index No: ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 ---D1D2C3C4C5C6P7P8F9 iii. Uganda Advanced Certificate Education (A'Level) School Year Address Index No: ---ABCDEOF ---ABCDEOF ---ABCDEOF ---ABCDEOF ---ABCDEOF ---ABCDEOF iv. Other Academic Qualification (If any) Year Period attended the Institution: NB: Attach Photocopy of UNEB result slips and transcripts or certificates relevant for admission and which must be with the originals during registration. F. Health Fitness: Do you suffer from any recurrent illness? YesNo If yes, define your illness Name of Physician Place Emergency Call Telephone
