Page 1

UNIVERSITY OF ZIMBABWE
UNDERGRADUATE ADMISSION APPLICATION FORM
NB: First read the NOTES on the next page and then complete all sections of the form but DO NOT write in the coloured boxes
which are for official use only. Print clearly in ink in the blank boxes and on the dotted lines as required.

1. FOR OFFICIAL USE ONLY

1.8

CERTIFICATES RECEIVED/VERIFIED

1.1

DATE OF RECEIPT

1.2

RECEIPT NO.

1.3

AMOUNT

1.4

APP. NO.

A Level

1.5

DATE OF DISPATCH

University

1.6

DATE RECEIVED

1.7

ACKNOWLEDGED

Birth
Marriage
I.D.
O Level

Other

2.

PERSONAL DATA
2.1

SURNAME(S)

2.2

FORENAME(S)

2.3

DATE OF BIRTH Day (e.g. 15) Month (e.g. 04) Year (e.g. 2014)

2.4

TITLE e.g. MR/MRS/MISS/DR/MS/REV/SR: (If Mrs, attach marriage certificate)

2.5

PREVIOUS SURNAME

2.6

MARITAL STATUS e.g. Married (M); Single (S);Divorced (D); Widowed (W)

2.7

PLACE OF BIRTH ..............................................................................................................................................................

2.8

SEX: Male (M); Female (F)

2.9

ID NUMBER ........................................................................................................................................................................
(attach certified copy of ID)

2.10

RACE

2.11 NATIONALITY

2.12

RELIGION ...........................................................................................................................................................................

2.13

ARE YOU A PERMANENT RESIDENT OF ZIMBABWE? Yes (Y); No (N)

IF NO WHAT PERMIT DO YOU HOLD, IF ANY? ..................................................................

(attach certified copy)

2.14

CITIZENSHIP ....................................................................................................................................................................

2.15

PERIOD/YEARS OF RESIDENCE IN ZIMBABWE ...........................................................................................................

2.16

DO YOU SUFFER FROM ANY PHYSICAL OR OTHER DISABILITIES FOR WHICH SPECIAL
ARRANGEMENTS AT UNIVERSITY WOULD BE REQUIRED/ Yes (Y); No (N) .....................................
IF YES PLEASE GIVE DETAILS ....................................................................................................................
...........................................................................................................................

DISABILITY CODE

Page 2
*2.17 ADDRESS
..................................................................................................................................................................................................
..................................................................................................................................................................................................
..................................................................................................................................................................................................
..................................................................................................................................................................................................

TELEPHONE NUMBERS:

Home: .............................................................................................................................
Cellphone: ......................................................................................................................

EMAIL ADDRESS: ...................................................................................................................................................................

*N.B. All correspondence will be forwarded to the above address.

3.

IMPORTANT NOTES TO ALL APPLICANTS

3.1.

All applicants must complete all sections of the application form carefully and legibly. If the University discovers that
any information submitted by the applicant is false, it will reject that application and may refer the matter for legal
action.

3.2.

All applicants must endorse at the bottom of this page that they have understood the notes given below and that
they agree to their application being considered under the conditions outlined below.

3.3.

Students who wrote A level examinations should ensure that the correct centre and candidate numbers are
inserted on page 3 of this application form.

3.4.

Applicants should submit this form to the Admissions Office, P O Box MP 167, Mount Pleasant, Harare, Zimbabwe,
and fill in their names and addresses on the attached card. This card will be returned to them in due course as
acknowledgement of our having received their application.

3.5.

The closing date for receipt of applications for admission is as advised in the published advert.

3.6

Late applications may be considered but must be accompanied by a non-refundable late application fee of
US$70. Cheques and postal orders are not acceptable. No late applications will be considered after the date as
indicated in the advert.

3.7.

All applicants MUST submit, with this form, photocopies (NOT originals) of all qualifications/certificates referred to in
the application including birth certificates and I.D. cards. The copies of certificates must be certified by a
Commissioner of Oaths or Head/Principal of the institution at which the examinations were taken or are being
taken.

Page 3
4. SCHOOL EXAMINATIONS FOR WHICH RESULTS ARE KNOWN
(List in chronological order, ALL subjects taken and results, including failures, and attach certified copies of certificates)
DATE
Month

Year

EXAMINING BODY
LEVEL
(e.g. ZIMSEC, Cambridge) (e.g. O, M, A, CSC, etc.)

SUBJECT

RESULT/
GRADE

O
English Language
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------O
Mathematics
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------A
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

5. PROGRAMME AND SUBJECT CHOICE

NB. Subject choice is available for only HAG, BAA and HEN.
5.1 First Preference: Degree Programme ................................................................................................................................................
Subjects
(if applicable)

1
2
3

5.2 Second Preference: Degree Programme ...........................................................................................................................................

1
Subjects
(if applicable)

2
3

Page 4
6. SCHOOLS ATTENDED (or College or Polytechnic at which school-leaving examinations were taken)
6.1

PRESENT SCHOOL OR LAST SCHOOL ATTENDED .................................................................................................

(If outside Zimbabwe, indicate country) (Name) ............................................................................................................
.......................................................................................................................................................................................
PERIOD OF ATTENDANCE: START YEAR (e.g. 01)
END YEAR (e.g. 02)

7.

PROSPECTIVE SPONSOR(S)
(e.g. Self; Government; or other organization: Please state name)
ARE YOU A UNIVERSITY STAFF DEPENDANT (i.e. wife, husband or child)?
ARE YOU A UNIVERSITY STAFF MEMBER?

Yes/No (delete the inapplicable)

Yes/No

IF YES PLEASE GIVE NAME, DEPARTMENT AND TELEPHONE EXTENSION OF STAFF MEMBER
...................................................................................................................................................................................................

8. CHECKLIST
8.1

HAVE YOU COMPLETED PAGES 1, 2, 3 and 4 (Delete the inapplicable)

YES/NO

8.2

HAVE YOU SIGNED THE FORM?

YES/NO

8.3

HAVE YOU PAID THE APPROPRIATE APPLICATION FEE?

YES/NO

8.4

HAVE YOU FILLED IN YOUR CORRECT DATE OF BIRTH?

YES/NO

8.5

HAVE YOU ENCLOSED A CERTIFIED COPY OF YOUR

(i)

BIRTH CERTIFICATE?

YES/NO

(ii)

NATIONAL IDENTITY CARD?

YES/NO

(iii)

O LEVEL CERTIFICATE?

YES/NO

(iv)

A LEVEL CERTIFICATE (if you have any June results)

YES/NO

(v)

OTHER CERTIFICATE(S) (Specify)?

YES/NO

NB: IF YOUR ANSWER TO ANY OF THE ABOVE QUESTIONS IS NO, PLEASE EXPLAIN: ..................................................
.........................................................................................................................................................................................................
I DECLARE THAT THE INFORMATION I HAVE GIVEN IS CORRECT, AND THAT SHOULD IT BE FOUND TO BE
FALSE MY APPLICATION WILL BE DISQUALIFIED AND I WILL FACE LEGAL ACTION.
SIGNATURE OF APPLICANT .....................................................................................

DATE