ISLAMIC UNIVERSITY IN UGANDA

EN

IUIU

inibetsy APPLICATION FORM FOR ADMIssION FOR UNDERGRADUATE STUDIES.

Academic session. 20- /20 Campus: Mbale/Kampala/Arua/Females' Campus/ (Circle one)

20

Section A: Personal Details.

Current
Type or print in Block letters.
Passport
Photo
Title. Dr.,Mr., Mrs., Miss., Sheikh. (Circle one).

Surname

First name. Gender: Male Female

Other names. Date of birth.

Marital status. Nationality.

If married, Names of spouse. .Occupation.
Contact address.

Religion. Sect.
Physical or y
any other form of disability that may require special attention.

Section B: Student Contact Information.

Postal Address.

Physical Address (Village). .Street. Town.

City. Telephone.
Correspondence address (if different).

Country of Permanent residence. Home District.

Telephone number(s). Fax number(s).

E-mail address.. .Current Occupation.
Next of kin details: Names.
..Occupation. .Relationship.
Aal
Telephone. Fax
.Physical address.

Names used here must be consistent with those which appear on your academic
documents
Section C: Application requirements.

The application form shall not be accepted unless the following admission requirements are attached;

DProof of payment for the application form (only original receipt are acceptable)

2)Certified copies of relevant previous academic awards eg. Result slips, transcripts, certificates, testimonials etc.

3)Copy of the birth certificate (c)

4)Copy of original Identity Card certified by the Headmaster of the previous school or your employer.

Note that Originals of the above (1-4) supplied documents shall be required at the time of registration
for further verification.

Section D: Choice of Campus, Academic System and Programme of Study.

NOTE: You must Register fora Course at one Campus only l Àlyai das iN:ala
At what Campus are you applying to study?

Main (Mbale) Kampala (Kibuli) Kabojja (Females only) |Arua Campus (Arua)

()
The University runs its programmes on Semester, Quarter and Term systems. There are two Semesters or three Quarters
in an academic year. Term system only applies for the Diplomain Law programme (four terms in an academic year)

See details of Programmes on either Semester or Quarter Systems for the various Campuses from the attached
"Campuses and Programmes Guide".
Please, indicate three choices of programmes you wish to apply for in order of preference. Indicate in the table below the
programme code (select from the Campuses and Programmnes Guide)

Programme Code Mode of study (Day/Evening/Weekend/External) Indicate 2Teaching Subject

y e yt /es l ys ) aleCombination (for Education
Applicants)
1st Js
2nd

3rd

N.B:lf any of your choices is either BA( Education), BSc (Education), DPE, BED, please indicate the teaching subjects
of your preference in the table above
Section E: Details of previous Academic Qualifications.

No Name of School/ Dates Subjectslyal Grades

College/ From To
Institute attended.

Primary School(s) Name:

(or the equivalent)
il y (a ) ll

10

Secondary School(s)
('0° Level ) ( or the
equivalent)

Name

10

11

12
 To ! Subjects yal Grades
High School(s) From
('A' Level) (or the
equivalent)

Other Qualification (s) From To ! Subjects ya Grades

Section F: Funding information (inancing your study at IÚIU).

i). Is the sponsorship Full/Partial

ii (Nameladdress of sponsor)
.Js

iii) If partial, how will you finance the balancef i S I`Á a g a s s

iv) If you are a self sponsored student, will you sustain this for the entire duration of the
Yes/No.
programme?
.Explain..
Section G: Referees
a reference of
Please, provide names and addresses of two referees below. Your referees should provide
Headmaster/Headmistress or
vour academicability as an undergraduate student. The referee should be your
Director of studies or Employer who is conversant with your academicpotential.

1) Referee's Names .Sjll

(Must be former Head teacher or Director of studies or Employer) ..dgiall
Address.

Telephone No. sFax No.

E- mail Address.. Relationship

with emphasis on character, physi

Comment on the Applicant's suitability for the type of course(s) chosen
cal fitness and academic ability

Comment on the Health of the Applicant

Comment on Applicant's general conduct.

Comment on the applicant's Attitude to Administrative staff.

Comment on the applicant's Relationship to fellow students..

Signature of Head teacher or Director of Studies or Employer

Date. Stamp.

2) Referee's Names
(Any other)
.olgin
Address..

Telephone No.. Fax No..

E- mail Address. Relationship

Signature of Head teacher or Director of Studies or Employer

Date. Stamp...
Section H: Preferred collection centre of the admission letter.

Tick in the box the preferred collection centre from which you will collect your admission letter: eaa

Main Campus Kampala Campus Arua Study Centre Females Campus

Note that there may be serious delays if sent by post.

Section I: Health Status

Do you have any serious health condition/disease? Yes/No.

Explain the condition..

Are you on regular medication? Yes/No....What medication?.

Who pays for such medication?.

Do yourequire any special medical attention while at the University?.

Note that: Itis the responsibility of the student to cover such specialized Medical Costs but not the univer

sity.

Would you wish to enroll for a University Health Insurance Plan (UHIP)? Yes/No.
Explain why.

Section J: Accommodation at Campus and outside campus. ialal gäs äla áual
New students are required to reside at campus at least during their first semester of their academic programme. Thereat
is done after admis
ter, they may apply to reside in gazetted hostels. Allocation of halls of residence and outside hostels
sions and registration on the first come first served basis.
 section K:
Declaration by Applicant.
Iconfirm that the
information Ihave given is true,
material information has been omitted. I am fully complete and accurate and no information requested or other
responsible for the validity of the information given above.

Note: DISCLAIMER: Applicants who do not

each programme and /or possess possess minimum qualifications as indicated against
qualifications
should not apply. It is the responsibility of the that are not recognized by government or its
applicant to ensure that he/she possesses agencies
qualifications and from recognized institutions. Any subsequent minimum
ment, as per lUIUAdmissions Policy including but not limited to discovery of violation of this require
incomplete information, impersonation and erroneous admission shall submission of false doCuments and
tion from the University or cancellation of award if lead to automatic discontinua
already obtained.

Signature of Applicant Date.

Return completed form with the original copy of the payment receipt of the application form toeither of
the following addresses and all relevant documents for further processing by 30" April of an academic
year.

The Academic Registrar

Islamic University in Uganda The Director Kampala Campus-Kibuli The Director Arua Campus
P.0.Box 2555, Mbale, Uganda Tel:+256-772 493 399 Tel:+256-392960450
Tel. 256-45-512-100 Ext. 236
Fax 256-45-44-33-502 The Director Females' Campus-Kabojja
E-mail. registrar @iuiu.ac.ug Tel:+256-772 888 338
E-mail:[email protected]
For University Use Only

Admitted for (Course) at ...Campusfor

Mode of study (day/evening/weekend/ external/distance learning)

Faculty. Department.

Reg. No. Hall of Residence

Not admitted because (Reason).

Sign of Academic Registrar.

Date..