University Of Namibia Form – Fill Out and Use

A: FULL & PART-TIME STUDIES UNIVERSITY OF NAMIBIA

Instruc ons: Use block le ers to complete this form where space is provided or place an ‘X’ in the correct square.

Incomplete applica ons will not be accepted. All cer fied documents will be filed - no copies will be returned to applicants.

SECTION 1: PROPOSED COURSE OF STUDY

Course of study for which you wish to enrol:

Campus

Full-Time

Part-Time

First Choice:

*Qualifica

on Code

Second Choice:

*Qualifica

on Code

(Your second choice will be considered if your first choice applica

on is unsuccessful.)

(* See insert for qualifica on code)

SECTION 2: APPLICANT’S PARTICULARS

Title:

Mr

Ms

Other

(specify)

Surname:

First Name in full:

Ini als:

SECTION 3: CONTACT PARTICULARS

(NOTE: Postal addresses or telephone numbers of schools or hostels are unacceptable for applica on purposes, since correspondence may be mailed to you well aŌer you have leŌ your school or hostel.)

FOR OFFICIAL USE ONLY:

ACCEPT FIRST CHOICE

ACCEPT SECOND CHOICE

RETURNED

REJECTED

CONDITIONS APPLICABLE:

SYMBOLS OBTAINED:

OVERALL POINTS OBTAINED:

ENGLISH

MATHEMATICS

BIOLOGY

PHYSICAL SCIENCE

SECTION 4: PERSONAL PARTICULARS

Date of Birth:

D

D

M

M

Y

Y

Y

Y

I.D. No.:

Passport No.:

Marital Status:

Single

Married

Gender:

M

F

Maiden Name:

(if applicable)

Mother Tongue:

Home Town:

Ci zenship:

Namibian

Other (specify)

If not a Namibian ci

zen, please apply for a study permit from your country of origin.

Do you have a disability?

Yes

No

(for planning purposes only)

If ‘yes’ please specify.

Based on your disability, do you have special needs?

Yes

No

Do you suffer from any nervous affec

on or mental abnormality?

Yes

No

(for planning purposes only)

If ‘yes’ please give details of the nature, severity,

date and dura

on of the illness.

Do you suffer from any other illness?			Yes			No		(for planning purposes only)
If ‘yes’ please give details of the nature, severity,	date and dura	on of the illness.
(Please note that you may be contacted.)

SECTION 5: EMPLOYMENT PARTICULARS (only if applicant is in full- me employment)

Name of Employer:

Your Occupa on:

Employer’s Postal Address:

Employer’s Telephone No.:

SECTION 6: APPLICANT’S NEXT OF KIN/LEGAL GUARDIAN PARTICULARS

(To be contacted in case of emergency.)

Family rela onship with the person whose par culars are supplied.

Title:

Mr

Ms

Other (specify)

Surname:

First Names in full:

Ini als

I.D. No.:

Home Address (next of kin/guardian):

Tel No.: Work

Tel. No.: Home

Cell No.:

Employer (next of kin/guardian):

Occupa

on:

Employer’s Address:

SECTION 7: FORMAL STATISTICAL INFORMATION

Region of Origin (if residing in Namibia) or country of permanent residence:

SECTION 8: SCHOOL LEAVING PARTICULARS

Last secondary school a ended:

Address of school:

Highest grade passed:

Current grade (if applicable):

Date of examina on:

Examina on number:

Examina on body:

Note: Current Grade 12 Scholars in Namibian secondary schools: Kindly submit the latest available School Rapport.

Note: A cer fied copy of your School Leaving Cer ficate should accompany this applica on. Please furnish your NAMIBIAN School Leaving Cer ficate (Grade 12) if you aƩended a Secondary School in Namibia.

LEVEL

ON = NSSC	IG = IGCSE	AL = A LEVEL	HG = HIGHER GRADE
NH = NSSC	HI = HIGCSE	OL = O-LEVEL	SG = STANDARD GRADE
			LG = LOWER GRADE

Interna onal students should note that only original School Leaving Cer ficates or an Advice of Results with a confirma on from the relevant Examina on Authority sta ng that cer ficates will be issued during the first year of registra on, will be accepted. No mock results or School Rapports will be considered.

SECTION 9: POST-SCHOOL ACADEMIC QUALIFICATIONS

Note: A full Academic Record issued by the ins tu on should accompany this applica on.

Student No.	From Year		To Year	Name of University/Technikon/College
Name of Programme (e.g. BA):					Awarded:	Y		N
Student No.	From Year		To Year	Name of University/Technikon/College
Name of Programme (e.g. BA):					Awarded:	Y		N
Have you ever been refused admission to any Ter			ary Ins tu on?			Y		N
Are you currently enrolled at the	University of Namibia?					Y		N
If ‘yes’ please indicate course of study.

SECTION 10: ACHIEVEMENTS

A.SPORT & CULTURE

Specify achievements and also the level(s) at which you have par cipated (school, club, regional, na onal):

B.GENERAL

Indicate any leadership posi ons held:

DECLARATION

Ihereby declare that all the par culars given in this applica on form are true and correct. I further declare that my enrolment as a student at the University of Namibia (UNAM) shall be subject to the terms and condi ons contained in the agreement, which I shall complete and sign at registra on.

FOR OFFICIAL USE ONLY:

APPLICATION FEE RECEIVED: _____________	RECEIPT NUMBER:_________________________
LATE FEE RECEIVED: ____________________	RECEIPT NUMBER:_________________________