THE CATHOLIC UNIVERSITY
OF ZIMBABWE
OFFICIAL STAMP
Undergraduate Application Form
Please complete all sections of the form in BLOCK CAPITALS. Use BLACK or BLUE INK ONLY
Degree choice (tick one) STUDY MODE (tick)
Bachelor of Business Management & Information Technology Honours
Bachelor of Arts Dual Honours Full Time:
Bachelor of Theology Honours Parallel:
B.A Block Release Program Block:
Short Course choice
Certificate in Project Management, Monitoring and Evaluation.
Certificate in Peace Building Studies.
Certificate in Church Administration and Counselling.
Certificate in Computer Literacy
Certificate in NGO Management
Certificate in Sustainable Business Management
Certificate in Management of Labour Relations.
Certificate in Quality Assurance and Management.
SECTION 1: APPLICANT DETAILS
1.1 TITLE (MR/MRS/MISS/MS) :
1.2 SURNAME: L A S T N A M E
1.3 FIRST NAME: B I R T H E N T R Y N A M E (S)
1.4 MARITAL STATUS: MARRIED SINGLE WIDOWED DIVORCED
1.5 GENDER: MALE FEMALE (tick)
1.6 CITIZENSHIP:
1.7 NATIONAL I.D NUMBER:
1.8 DATE OF BIRTH D D M M Y Y Y Y
1.9 COUNTRY OF BIRTH:
-
1.10 CITY / TOWN / AREA OF BIRTH
1.12 PHYSICAL ADDRESS:
+
1.12 PHONE:
1.13 E-MAIL: ________________________________________
1.14 RELIGION & DENOMINATION: ________________________________________
1.15 HEALTH:
Do you suffer from any physical or other disabilities for which special arrangements would be required at the University?
If yes give details. (Delete Inapplicable) Yes No
_______________________________________________________________________________
2. LEGAL GUARDIAN DETAILS
2.1 NAME AND SURNAME:
+
CONTACT NUMBER(S)
ADDRESS
Relationship ______________________________________________
(Legal Guardian) _________________________________ (Date signed) D D M M Y Y Y Y
3. NEXT OF KIN DETAILS
3.1 NAME AND ADDRESS:
3.2 PHONE: +
3.3 (Next of kin) ________________________________ (Date signed) D D M M Y Y Y Y
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4. ACADEMIC QUALIFICATIONS
*(APPLICANTS MUST SUBMIT CERTIFIED COPIES OF ALL CERTIFICATES)
4.1 ‘O’ LEVEL
SECONDARY SCHOOL ATTENDED _______________________________________________
D D M M Y Y Y Y T O D D M M Y Y Y Y
SUBJECT EXAMINATION BOARD DATE OF EXAM GRADE/RESULT
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
D D MM Y Y Y Y
4.2 “A” LEVEL QUALIFICATIONS
SECONDARY SCHOOL ATTENDED: __________________________________________
D D M M Y Y Y Y T O D D M M Y Y Y Y
SUBJECT EXAMINATION BOARD DATE OF EXAM GRADE/RESULT
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
4.3 OTHER POST ‘O’ LEVEL QUALIFICATIONS:
SUBJECT AWARDING BOARD DATE OF EXAM GRADE/RESULT
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
5. FINANCIAL SUPPORT
5.1 WILL YOU (OR YOUR GUARDIAN) BE ABLE TO PAY YOUR UNIVERSITY TUITION FEES? YES NO
IF YES NAME OF INDIVIDUAL RESPONSIBLE FOR PAYING TUITION FEES
______________________________________________________________________________________
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PHONE: +
E-MAIL: ______________________________________________
5.2 WILL YOU APPLY FOR A GOVERNMENT SUPPORTED LOAN? YES NO
IF YES NAME OF INDIVIDUAL WILLING TO BE A GUARANTOR
NAME: _________________________________________________________________________
PHONE: ________________________________________________________________________
5.3 OTHER SPONSORSHIP (PLEASE SPECIFY)_______________________________________________
_______________________________________________________________________________
6. EMPLOYMENT HISTORY (MOST RECENT POST ‘O’ LEVEL ONLY)
POSITION DATE(from) DATE(to)
NAME & ADDRESS OF EMPLOYER (DDMMYYYY) (DDMMYYYY)
HELD
7. REFERENCES
Give the names of TWO (2) referees willing to provide you with character references.
*Name: ___________________________________________ *Name: ______________________________________
Address: ___________________________________________ Address: ______________________________________
*Phone: ___________________________________________ *Phone: ______________________________________
8. DECLARATIONS
We confirm that information provided in this form is accurate to the best of our knowledge
SIGNED ____________________________ SIGNED ______________________________
APPLICANT LEGAL GUARDIAN
DATE ______________________________ DATE: ________________________________
FOR OFFICIAL USE ONLY
D D M M Y Y Y Y CERTIFICATES RECEIVED
DATE RECEIVED:
YES NO
BIRTH CERTIFICATE
RECEIPT NO: NATIONAL ID
“O” LEVEL
APPLICATION NO: ____________________
“A” LEVEL
MARITAL STATUS: ENTRY TYPE:
____________________ ____________________
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