Prentry LLB App Form 2017 2018 PDF
Prentry LLB App Form 2017 2018 PDF
Prentry LLB App Form 2017 2018 PDF
P.O. BOX 7062 Kampa la Uga nda Tel: + 2 5641 5 33 332/533 258
Cables: " MA KUNIKA" Fax: +256414534125/ 45 41771
website : www.makerere.ac. ug E-mail: ar@acadreg .mak.ac.ug
Note: This form must be subm itted with evidence of payment of the Application fee
PART 1
To be completed in CAPITALS by the Applicant.
ALL NAMES MUST BE WRITTEN IN FULL AS INDICATED ON . 0' LEVEL OR ANY OTHER ACADEMIC
DOCUMENTS
1. (a) Surname (in full) ................ ............................ ....................... ...... .. ....... .
(b) 'A' Level Index No. .............. ........... .... .......... Year of A' Level Examinat ion ... .. .............. .. ..
(c) Other names (in full), no Initials ..... .. ......... ...... ... .. ............ ... ........ .. .. ....... ....................... .... .
(d) Gender: (Tick), Male 0 1 Female 0
(e) Date of Birth (DO ..........MM ...........YY ..... .... .. ) (e) Citizenship ... .................... ..... .. .... .......... .
(You must attach a copy of the Birth Certificate)
SUMMARY OF GRADES
~CTIONS I CREDITS I PASSES
You must attach a photocopy of the Uganda Certificate of Education(UCE) or its equivalent.
Year of Examination ........ ...... .. ......... .. ..... .. ..... \ A' Level Points .............................. ....... .......... ..
Attach a photocopy of the UACE Certificate or its equivalent (Strictly a photocopy of the
Certificate or Result Slip must be attached where applicable.)
-'
5. DIPLOMA/DEGREE HOLDERS/MATURE AGE (Tick where applicable)
Inst'I tU t"Ions Attend e d" Iof any
Year Name of Qualification Class of Award
From To Institution obtained (if any)
PART II
6. Other Personal Information
(a) Marital Status (married, single, other. Please specify) .... .. .............. ............ ......... ...... ... .. ...... .... .
(b) Permanent Address ........... ..... .... ............................. .. .... ............. .... ..... ........ ... .... ..... ............ ......
(c) Emergency contact Address, if different from (b) above ... .. .. ......... ... ...... .... .... .... .............. ... .. .
(d) Telephone No....... .. .. ....... .......... .. (e) Fax No. (If applicable) ......... .. ....... ....... .............. ..
(f) E-Mail ........... .. ................ .................... ....... ........ ... .. .. .. ......... ....... .. ............. ...... .. .............. ... ....... .
(g) Relig ious affiliation (if any) .... ......... ...... ............ .. .. ......................... ... .. ..... ...... ............... ........ ..
(b) Parent's/ Guardian's address......................................... Cd) Tel. Number ....... ....... .. ..................... .
8. Give 2 names of persons in responsible positions f rom whom confident ial information about you may
be obtained if necessary.
f) Name........... .. ... ....... .. ...... ....... .. ... ... .. .... ... ........ ..... .. .. .. .. ... .......... ... ...... ..
Address ......................... ....... .... .. .. ......... ........... ... ... .. .. .. .................... .... .
E-mail: ................. .. ............ ... ...... ... ... .......... ... ........ ....... ........ ... .......... ..
Telephone Number ..... ......... ... ..... ........... .. .......... .... .... .. .. .. ........ ......... .
Address ......... ....... ......... .... .......... ............. .. ........... ........... ....... .......... .
E-mail: ...................... .. ....... ........ ........... ........ ................. ... .... ...... .... .. .