COMBRIDGE CENTRE FOR POLYTECHNIC STUDIES PHOTO
OFFICE OF THE ACADEMIC REGISTRAR
Nyamityobora, Kakoba Division, Mbarara City
ACCOUNT NO
150 meters from Uganda Bible Institute, Ankole
P.O BOX 177267, MBARARA
ABSA Bank: 600 880 6940
(+256) 414 674 018
APPLICATION FOR ADMISSION TO UNDERGRADUATE PROGRAMMES: YEAR………………….
NOTE: Transcript copies of Primary, Ordinary Level and Advanced Level results slips/certificates and other relevant qualifications, valid identification
documents and birth certificate should be attached to this form. Foreign students should attach their immigration facilities and identity cards.
All academic records in a language other than English must be accompanied by a certified English translation. At registration, originals shall be required.
All successful applicants shall be required to pay Tuition fees deposit (commitment fees) of at least 100,000 Ugx at the time of collecting admission letters.
An applicant is required to pay 50,000 Ugx for the application form in any of the above bank accounts.
1.0 SECTION ONE: CHOICES
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1.1 Choice of intake: January: January May August
1.2 Choice of Programmes
Choice Programme Session
1st choice
2nd choice
3rd choice
2.0 SECTION TWO: PERSONAL DATA
2.11 Name :( Surname, other Names)
…………………………………………………………………………………………………………………………
2.12 Tittle: (Mr., Miss, Mrs., Ms., Rev.) ……………………………………………………………………………..………………………………………...
2.13 Gender: Male: Female: Date of Birth: dd………..mm…………yy………..………………………...
2.14 Marital Status: Married Single
2.15 Religious Affiliation:…………………………… Denomination………………………………………………..................................................
2.16 Nationality:……………………………………. Country of Residence……………………………………………………………………………….
2.17 Postal Address:…………………………………………………………………………………………………………………………………………………
2.18 Home District:……………………………………. Home diocese……………………………………………………………………………………...
2.19 Telephone Contact(Iclude country code)…………………………………………………………………………………………………………….
2.20 E-mail……………………………………………………………………………………………………………...............................................................
3.0 SECTION THREE: DISABILITY
Do you have any disability? Yes No
Chronic Illness
Physical Disability
Impairement (Hearing, Speaking, Seeing, etc)
Others; Briefly state the nature of disability……………………………………………………………………………………………………......
4.0 SECTION FOUR: PARENTS/SPONSOR/OTHER NEXT OF KIN
Name Phone Email Address
Father
Mother
Sponsor
Other next of kin
5.0 SECTION FIVE: EDUCATION BACKGROUND
Please provide information about your PLE, UCE , UACE or their equivalence.
Qualification Name of school Index No. Exam Year
PLE
UCE
UACE
5.1 Other post- secondary qualifications.
Please state the colleges and or universities attended (give names ,dates,qualifications and grades and attach copies of each)
Name of Education Institution Qualification attained Grades/Class/GPA
5.2 Did you sit for mature entry examination? Yes No
If yes, please state the year of sitting………………………………………………………………………………………………………………………….
Index No……………… and awarding/ examining institution……………………………………………………………………………....................
(A copy of mature age entry exam certificate MUST be attached to this form)
6.0 SECTION SIX: ACCOMMODATION
Meals and accommodation are part of tuition fees for boarding students however, day scholars are supposed to pay
85% of the tuition fee with lunch provided or 75% without lunch.
7.0 SECTION SEVEN: COMMITMENT FEES
Applicants admitted will be required to pay a commitment fee of 100,000 Ugx at the time of picking the admission letters
which will be part of tuition fees.
8.0 SECTION [Link]
I declare that all the information given in this application form is true and correct to the best of my knowledge
Name of applicant …………………………………………………………………………………………………………………………………………………...
Signature of the applicant…………………………………………………………………………………………………………………………………………
Date ……………………………………………………………………………………………………………………………………………………………………….
9.0 SECTION TEN: FOR OFFICIAL USE ONLY
I declare that on the basis of the documentary evidence availed, the student is hereby registered
for……………………………………………………………………program.
Officers name…………………………………………………………………………………………………………………………………………………………..
Signature……………………………………………………. Date………………………………….
……………………………………………………………………………………………………………. (Official Stamp)