OFFICIAL STAMP
THE CATHOLIC UNIVERSITY OF ZIMBABWE
Undergraduate Application Form
Please complete all sections of the form in BLOCK CAPITALS. Use BLACK or BLUE INK ONLY
(tick one) Degree choice
Bachelor of Commerce Honours Degree in Business Management & Information Technology
Bachelor of Commerce Honours Degree in Accounting
Bachelor of Commerce Honours Degree in Business Management
Bachelor of Arts Dual Honours Degree
Bachelor of Social Science Honours Degree in Development
Bachelor of Education Honours in Primary Education
Bachelor of Education Honours in Early Childhood Development
Bachelor of Theology Honours Degree
STUDY MODE (tick) Full Time/Conventional: Full Time/Parallel: Block:
SECTION 1: (APPLICANT DETAILS)
1.1 TITLE (MR/MRS): ……….
1.2 SURNAME (S):
1.3 FIRST NAME:
1.4 MARITAL STATUS: MARRIED SINGLE WIDOW DIVORCED
1.5 GENDER: MALE FEMALE (tick)
1.6 CITIZENSHIP:
1.7 NATIONAL I.D NUMBER: -
D D M M Y Y Y Y
1.8 DATE OF BIRTH
1.9 COUNTRY OF BIRTH:
1.10 CITY / TOWN / AREA OF BIRTH
1.11 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. Yes No (delete inapplicable)
__________________________________________________________________________________
www.cuz.ac.zw
2. LEGAL GUARDIAN DETAILS
(GUARDIAN)
2.1 NAME AND SURNAME:
CONTACT NUMBER(S) +
ADDRESS
RELATIONSHIP: ……. ………….. _____________ D D M M Y Y Y Y
(Legal Guardian) (Date signed)
3. NEXT OF KIN DETAILS
3.1 NAME AND ADDRESS:
+
3.2 PHONE:
………………………… D D M M Y Y Y Y
(Next of kin) (Date signed)
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
2
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: EXAM LEVEL: ______________________
SUBJECT AWARDING BOARD DATE OF EXAM GRADE/RESULT
DDMMYYYY
DDMMYYYY
DDMMYYYY
DDMMYYYY
5. FINANCIAL SUPPORT
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
______________________________________________________________________________________
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
HELD (DDMMYYYY) (DDMMYYYY)
3
REFERENCES
Give the Names of TWO (2) referees willing to provide you with a 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
DATE RECEIVED:
RECEIPT NO:
APPLICATION NO: ____________________
CERTIFICATES RECEIVED
YES NO
BIRTH CERTIFICATE
NATIONAL ID
“O” LEVEL
“A” LEVEL
MARITAL STATUS: _____________
ENTRY TYPE: ____________________
