Undergraduate Programmes Application Form ACADEMIC YEAR 2014/15 (For Unallocated Students)

UNDERGRADUATE PROGRAMMES
APPLICATION FORM
ACADEMIC YEAR 2014/15 (For unallocated
students)
Reference number (Generated at first application).
INSTRUCTIONS:
1. Read the application form carefully before filling any information. Give detailed information.
2. This form can be completed electronically or by hand. Please write clearly and in
CAPITAL/BLOCKS LETTERS.
3. The Completed application form must be Submitted to the office of the Academic Registrar to
nearest UR campus except Rusizi, Nyamishaba and Rubirizi, with Bank Slip of RWF 5000 non
refundable application fees paid at the account number 5044380-01-93/RWF UR-Internal
Revenues open at I&M Bank (Former BCR) OR Account number 0094-0637830-21/RWF URInternal Revenues open at Bank of Kigali (BK). N.B. Students who have already made
payment during their first application are not required to pay again. They should show
proof earlier payment or provide the reference number used during the payment.
4. Attach copies of your Senior Six (S6) certificate, photocopy of your National ID card or valid
passport. Applicants who did not complete their secondary education in Rwanda must present
the equivalency of their results as issued by the Rwanda Education Board (REB).
The
University of Rwanda (UR) reserves the right to verify the provided information as well as
results from REB and WDA databases.
5. Your application will not be considered unless this form is completed in full and all the required
documents are attached.
6. Closing date 21st July 2014.
Page 1 of 6
Section A: Personal details:

(Please give your name as it appears in your national ID or passport. It is essential that the University
is notified of any change of contact details at the earliest opportunity)
1. Surname/Family name: _________________________________________________________________

2. First name: _______________________________________________________________________________
3. Forename/Other name: _________________________________________________________________
4. Date of birth (Day/Month/Year): ______________________________________________________
5. Gender: Male
Female
6. Nationality: _______________________________________________________________________________
7. ID Card/Passport number: ______________________________________________________________
8. Marital status: Single:
Married:
Widowed:
9. Name and Address of Guardian/next kin:______________________________________________

___________________________________________ Tel.:____________________________________________
10. Do you have any physical disability (State it, if any): _________________________________
Section B: Contact details:

Permanent (Home) address:
Work postal address:
Province: ________________________________
Province: ________________________________
District: _________________________________
District: _________________________________
Sector: ___________________________________
Sector: ___________________________________
Cell: ______________________________________
Cell: ______________________________________
Post code: _______________________________
Post code: _______________________________
Tel. No: __________________________________
Tel. No: __________________________________
Mobile phone: __________________________
Mobile phone: __________________________
Email: ___________________________________
Email: ___________________________________
Page 2 of 6
Section C: Academic programmes applied for:

(Please indicate the name of College, programme and mode of attendance by which you wish to study.
It is advisable to take into consideration the College minimum entry requirements. Refer to the
Application Guide document available on the UR website: http://www.ur.ac.rw )
FIRST CHOICE
1. College: ______________________________________________________________________________
2. Academic Programme:__________________________________________________________________
3. Campus: _______________________________________________________________________________
4. Mode of study:
Day time
Evening time
(In case your first choice is not successful, indicate your preference for the second choice)
SECOND CHOICE
1. College: ______________________________________________________________________________
2. Academic Programme:__________________________________________________________________
3. Campus: _______________________________________________________________________________
4. Mode of study:
Day time
Day time
Evening time
Evening
Page 3 of 6
(In case your second choice is not successful, indicate your preference for the third choice)
THIRD CHOICE
1. College : ________________________________________________________________________________
2. Academic Programme:___________________________________________________________________
3. Campus : ________________________________________________________________________________
4. Mode of study :
Day time
Evening time
Section D: Previous education:

(Please provide details, including results of all secondary education or professional qualifications you
have obtained, starting with the most recent; and attach copies of certificates and transcripts
wherever possible)
Name and address of School/College: _____________________________________________________________________
_____________________________________________________________________________________________________________________
Period (academic year)
From
To
Qualification &
Combination
Main subjects
Grade
obtained in
each subject
Examination
Authority/Board
Page 4 of 6
Section F: Professional experience (If any):

Organization
Period
From
Position
Nature of job
To
Section G: Declaration:
All decisions by University of Rwanda are taken in good faith on the basis of the
information the applicant provides. In case of false statement(s) and/or document(s), the
University of Rwanda reserves the right to take appropriate action.
By signing this application form, the applicant declares that particulars furnished above
are correct to the best of his/her knowledge.
Applicant Name: _________________________________________________________________________
Date: _____/_____/________________; Signature: ____________________________________________
Page 5 of 6
FOR OFFICIAL USE ONLY

ACTION
REMARKS
Applicant admitted (specify

program)
Applicant admitted conditionally
(state conditions)
Applicant rejected
(state the reason)
Name and Signature College Registrar
Date
Page 6 of 6

Undergraduate Programmes Application Form ACADEMIC YEAR 2014/15 (For Unallocated Students)

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UNDERGRADUATE PROGRAMMES

Section A: Personal details:

1. Surname/Family name: _________________________________________________________________

9. Name and Address of Guardian/next kin:______________________________________________

Section B: Contact details:

Work postal address:

Post code: _______________________________

Post code: _______________________________

Tel. No: __________________________________

Tel. No: __________________________________

Mobile phone: __________________________

Mobile phone: __________________________

Section C: Academic programmes applied for:

Section D: Previous education:

Section F: Professional experience (If any):

Date: ___/_/; Signature: ______________________________

FOR OFFICIAL USE ONLY

Applicant admitted (specify

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