ZAMBIAN OPEN UNIVERSITY
P. O. BOX 31925
LUSAKA
Application No:……………
Receipt No:………………..
Received by:………………
Date:………………………
(tick Full-time/ Part-time )
FULL-TIME
PART-TIME
FOR OFFICIAL USE ONLY
REGISTRAR’S COMMENT:
________________________________________________
________________________________________________
________________________________________________
APPLICATION FOR ADMISSION TO DEGREE, DIPLOMA OR CERTIFICATE PROGRAMMES
PROGRAMMES AVAILABLE (tick programme applied for)
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Bachelor of Education
B.Ed Secondary
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B.Ed Early Childhood
Education
Bachelor of Laws (LL.B)
Bachelor of Arts in Policing and Security Studies
Bachelor of Arts with Development Studies (BA Development Studies)
Bachelor of Business Administration
Bachelor of Business in Human Resource Management
Bachelor of Business in Accounting
Bachelor of Business in Banking and Finance
Bachelor’s Degree in Marketing
Bachelor’s Degree in Public Relations
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Bachelor of Science in Financial Mathematics and Statistics
Bachelor of Science ( Agribusiness Management)
Bachelor of Science ( Agricultural Economics)
Bachelor of Arts in Governance and Public Administration
Diploma in Early Childhood Education
Diploma in Civic Education
Diploma in Policing and Security Studies
2
FULL NAME (Surname, Middle name, First name)
Surname
Other names
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5
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SEX
Male - M
Female - F
DATE OF BIRTH
4.
D
D
MARITAL STATUS
M
M
Y
Married
Unmarried
Divorced
Y
NATIONALITY
NATIONAL REGISTRATION CARD NO.
PASSPORT NO: ____________________________________
POSTAL ADDRESS
9
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RESIDENTIAL ADDRESS
TELEPHONE NUMBER(S):
Work:___________________________________
Residential:___________________________________
E-mail:___________________________________
11 LAST SECONDARY SCHOOL/ INSTITUTION ATTENDED
(give dates)
___________________________________________________________________________
_______________________________________________________________
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“O” LEVEL OR EQUIVALENT EXAMINATION PASSED AND GRADES ATTAINED IN
EACH SUBJECT
SUBJECTS
GRADES
NAME OF EXAMINATION
_______________________
______________________________
_______________________
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_______________________
______________________________
_______________________
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______________________________
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_______________________
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Please enclose copy/ies of statement of results or/and certificate/s
13 ANY OTHER QUALIFICATIONS OBTAINED
i. Degree/s
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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ii. Diploma/s
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
iii. Certificate/s
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
IF YOU HAVE BEEN PREVIOUSLY ENROLLED AS A STUDENT AT ZAOU INDICATE
YOUR STUDENT NUMBER:------------------------------------------------
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___________________________________________________________
ARE YOU CURRENTLY ENGAGED IN ANY STUDIES?
Yes/No:____________________________________________________________________
___________________________________________________________________________
_________________________________________________________
(if ‘Yes’, state the nature and type of studies and qualification sought, including
examining body).
16
DO YOU HAVE ANY PHYSICAL OR COMMUNICATION DISABILITY?
a.
circle
1.
Vision
2.
Mobility
3.
Speech
4.
Hearing
5.
Others
b.
if any of the above give details of disability_________________________
____________________________________________________________
____________________________________________________________
17 ARE YOU:
a.
b.
c.
A child of a Member of Staff
A Member of Staff
A spouse of a Member of Staff
18 FILL THIS PART IF YOU ARE PRESENTLY EMPLOYED
iv. Type of Employment or Job:______________________________________
v. Name of Employer:_____________________________________________
vi. Address of Employer:___________________________________________
vii. Period of Service:_____________________________________________
19
NAME ADDRESS AND PHONE NUMBER OF NEXT OF
KIN:_________________________________
___________________________________________________________________________
___________________________________________________________________________
_______________________________________________________
20 RELATIONSHIP______________________________________________________
21 SPONSORSHIP FOR STUDY
i. Self (tick)__________________________
ii. Other (state)________________________
22 SIGNATURE OF APPLICANT:_______________________ DATE:______________