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Application Form

This document is an application form for Mulungushi University's degree programs. It requests personal details from the applicant, including name, date of birth, contact information, and nationality. It asks for information about the applicant's educational background, including schools attended, exam results, and any professional qualifications. The applicant must select their first and second choice programs from those offered by the University. The form is to be filled out in three parts - by the applicant, their sponsor, and then the University's use for acceptance/rejection. It provides instructions on submitting the completed form before the listed deadline.

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fmushaukwa
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© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
9K views

Application Form

This document is an application form for Mulungushi University's degree programs. It requests personal details from the applicant, including name, date of birth, contact information, and nationality. It asks for information about the applicant's educational background, including schools attended, exam results, and any professional qualifications. The applicant must select their first and second choice programs from those offered by the University. The form is to be filled out in three parts - by the applicant, their sponsor, and then the University's use for acceptance/rejection. It provides instructions on submitting the completed form before the listed deadline.

Uploaded by

fmushaukwa
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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K100 000 / US $50

FORM: AC 01A

MULUNGUSHI UNIVERSITY

DEGREE APPLICATION FORM


PART I
1.
PERSONAL DETAILS
Surname..

FOR OFFICIAL USE ONLY


Name

Other Names

Application Fee

Date of Birth

Receipt No.

Place of Birth...

Date.

Sex : Male

Signature

Female

NRC/Passport No..Nationality
Postal Address
..
.
Tel/Cell/ /Fax /E Mail
2.

Title of Course( First Choice under 8 Below)

3.

SPONSORS
Name of Sponsors/Employer
.
Address:..If different from above)
..

Tel/Fax/E-Mail.

4.

EMPLOYMENT (If Possible)


Position you now hold:.Since when...


List of other posts held (giving dates, Starting and finishing)

5.

POST

DATES

(A) ..

(B) ..

(C) ..

EDUCATION
Schools attended (Years and level of attainment)
..

.
GRADE 12/FORM 5 EXAMINATIONS NUMBER

EXAMINATION BODY

YEAR

Indicate O level subjects or equivalents passed and grades scored in the space
provided below:
SUBJECT

OFFICIALUSEONLY

SubjectCombination
Points

GRADES


6.

A Level subjects (If applicable)


SUBJECT

GRADES

OFFICIALUSEONLY

7.

PROFESSIONAL QUALIFICATIONS
Professional training /courses attended since leaving school
INSTITUTION
QUALIFICATION
DATE OBTAINED
.
.

..

..

NOTE: Attach certified copies of certificates.


8.

PROGRAMMES OFFERED
SELECT COURSES OF STUDY WHICH YOU WOULD LIKE TO BE CONSIDERED FOR
IN ORDER OF PREFERENCE ( 1ST and 2nd Choice) IN BOXES PROVIDED.
DEGREE PROGRAMMES
SCHOOL OF AGRICULTURAL DEVELOPMENT STUDIES
Agricultural Business Management
Land and Water Resources Management
SCHOOL OF BUSINESS STUDIES
Bachelor of Commerce
Bachelor of Entrepreneurship
SCHOOL OF SOCIAL SCIENCES
Bachelor of Human Resources Management
Bachelor of Social work
Bachelor of Physical Education

9.

Mode of study (Full Time, Distance).


Duration..Fromto

10.

Do you intend to apply for University Accommodation? Yes

No

(Tick)


11.

Have you consulted your employers/sponsors fully, regarding the application?


Tick Yes
No
(If so let your employers/sponsors complete Part II of this Form)
If accepted on the above course I undertake:(a)

To apply myself fully to my studies for the duration of the course and to
undertake the practical work, and

(b)

To comply with the rules and regulations of the University

Signed..Date
N.B Attach copies of your qualifications.

PART II
(TO BE COMPLETED BY SPONSOR)
1.

This is to Certify that I/We, am/are the Manager/Parent/Guardian


Name: (Block capitals) Mr/Mrs/Ms
Address

2.

I/We wish to sponsor him/her for the Mulungushi University /Degree


Course.

3.

I/We certify that the candidate has held the responsible position of (state posts
and duties held)..
..

4.

I/We are willing to release the applicant for the whole period of the course:
to..

5.

I/We guarantee that in the event of the above applicant being required to
undertake field work assignment for a month or more as part of the course, we
agree to offer support to the applicant.

6.

I/We further guarantee that if the above applicant is accepted for the course the
fees required will be paid to the University before or on the date of registration.
Signed.
Position..
RelationshipDate


PART III
(TO BE COMPLETED BY THE UNIVERSITY)
OFFICIAL USE ONLY
CANDIDATES APPLICATION
NO.

The application for Mr/Mrs/Miss.in the


following course ..
(a) Is accepted (b) is rejected ..
Signed.PositionDate..
This form must be returned, before the closing date/dead line indicated in the
advertisement to:
The Registrar - Academic
Mulungushi University
P O Box 80415
KABWE, Zambia
Tel: +260-05222141
Cell: 097 - 7889854
Tel: Fax +26005-224637
Email: [email protected]

NOTE: This form is not transferable.

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