Application Form
Wachemo University Office of the Registrar
Graduate studies programs Application form
Form No………………
FOR OFFICE USE ONLY
File No……………………. Fellowship/ Source of fund………………………………................
Specialization…………….. B.Sc/B.A/MSc/MA/MPH/MBA/MD+ Specialty or equivalent
degree...............................................................................................................................................
(To be filled out by the candidate) Please complete and send this form to:
Office of the Registrar
Wachemo University
P.O/.Box 667
E-mail………….......................
Tel. No………………………….
Fax……………………………
Hossa`ina, Ethiopia.
Personal Data (Please write in block letters)
Full Name…………………………………………………………………………………
Place and date of birth……………………………………………………………………
Sex……………Marital status…………………….Nationality……….…………………
Postal address……………………………………………………………….……………
City………………………………………..Country……………………………………..
Tel. No……………………………………..Cell phone……………………….……........
Fax………………………………………... E-mail ………………………….………….
FELLOWSHIP (Please mark in the boxes)
I will pay all my expenses (including research grant and tuition fee)
Fellowship is requested but has not yet been granted
Fellowship support is required
Fellowship has already been awarded
1
If the fellowship has been awarded, please indicate the name of the sponsor and attach
statement of award:
…………………………………………………………………......................................
....………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………………………………………………................................
Please mark one: MSc/MA/MBA/MPH/PhD program and specialization
Program (Example: Animal and Range Science)
Specialization
Example : MSc in Animal production
Academic records (start from recently obtained credentials)
University/college country Major field Diploma/degr Year of attendance
of study ee/masters From To
Employment Records (Start from the recent employer)
Name of Address Position(s) held Service year
employer/Organi From To
zation
2
Publications (if any)
Attach list of articles you have published, write the name of journal(s) and year of publication
…………………………………………………………………………………………………
…………………………………………………………………………………………………
……………………………………………………………………….......................................
Checklist of documents submitted (mark in the boxes)
Completed application form
Copy of Diploma/Degree/Masters
Copy of transcript (student copy)
Curriculum vitae
Sponsorship letter (if any)
Recommendation letters (3)
Statement by the applicant
I hereby certify that all the information given in this form is complete and correct. I fully
realize that the university is entitled to take any action on me; including dismissal if the
information given by me here is found incorrect or misleading at any time. I also realize that I
will not be entitled to any reimbursement of whatever fee I might have paid in cases where
the university takes any action on me as a result of the incorrect or misleading information
given by me. I further undertake to observe all the rules and regulations of the university if I
am accepted by the university, and to refrain from any activity which may be contrary to the
interest of Ethiopian people. I shall take full responsibility for reading and abide by the rules
and regulations of the University.
Date and place:…………………Signature: ………………………..........................................
ATTENTION! Please check the academic calendar of Wachemo University for the date of
entrance examination
