2023-2024 Distance Application Form
2023-2024 Distance Application Form
FORM AC 01A
Received by………………………
PART I
1. PERSONAL DETAILS
Surname……………………………………………………………………………………………
Other Names……………………………………………………………………………………….
Date of Birth……………………………………………………………………………………….
Place of Birth……….……………………………………………………………………………...
Postal Address……………………………………………………………………………………..
Residential Address……………………………………………………………………………….
Tel/Cell ………………………………………………………………………………………….....
E – Mail …………………………………………………………………………………………….
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Full-Time Application Form 2023-2024 Intake
FORM AC 01A
2. EDUCATION
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Indicate ‘O’ level subjects or equivalents passed and grades scored in the space provided
below:
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SUBJECT GRADES
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OFFICIAL USE ONLY
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(Subject
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Combination Points)
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Full-Time Application Form 2023-2024 Intake
FORM AC 01A
3. PROFESSIONAL QUALIFICATIONS
SCIENCE BASED
• Bachelor Science (BSc) in ICT with Education
• Bachelor of Science (BSc) in Mathematics with Education
• Bachelor of Science (BSc) in Agriculture with Education
• Bachelor of Science (BSc) in Mathematics and ICT with Education
• Bachelor of Science with Education (BSc ED) in any two of the following
subjects, one being a major and the other a minor:
-Biology
-Chemistry
-Physics
-Mathematics
ARTS BASED
• Bachelor of Arts with Education (BA ED), in any two of the following subjects,
one being a major and the other a minor
-English Language
-Zambian languages
-French
-Civic Education
-Religious Studies
-History
-Geography
• Bachelor of Arts with Education – Social Studies
• Bachelor of Primary Education
• Bachelor of Business Studies with Education (BBSED)
• Bachelor of Business Administration &Entrepreneurship with Education (BBAE
ED)
(b) Credit of better in Biology or Agriculture Science and Science or Physics and
Chemistry for those who took pure sciences and a credit (6) or better in any
other one (1) subject in the Zambian School Certificate or General School
Certificate of Education or Cambridge International Examinations.
DIPLOMA HOLDERS
5.4 Five (5) credits, which must include English language (Grade 6) OR Better
with a Diploma of a minimum of 18 months duration in the relevant field
from a recognised institution will be exempted from first year courses
and hence start at Second (2nd ) Year.
FROM THE ABOVE, SELECT COURSES OF STUDY WHICH YOU WOULD LIKE
TO BE CONSIDERED FOR ADMISSION IN ORDER OF PREFERENCE (1st 2nd
and 3rd Choice)
PROGRAMME OF CHOICE
1stChoice
2nd Choice
3rd Choice
Note that accommodation in the University is limited hence the need to make prior
arrangements in good time.
9. Have you consulted your employers/sponsors fully, regarding this application? Tick
Yes No
(If yes, let your employers/sponsors complete Part III of this Form)
Signed……………………………………………..Date………………………………………
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Full-Time Application Form 2023-2024 Intake
FORM AC 01A
PART II
PART III
TO BE COMPLETED BY SPONS
`OR OR NEXT OF KIN
Address…………………………………………………………………………………………….
3. I/We certify that the candidate has held the responsible position of (state posts and duties
held)………………………………………………………………………………………...
………………………………………………………………………………………………………..
4. I/We are willing to release the applicant for the whole period of the course:
………………………………………………………………………to……………………………..
5. I/We guarantee that in the event of the above applicant being required to undertake field work
assignment for a month or more as part of the course, we agree to offer support to the
applicant.
6. I/We further guarantee that if the above applicant is accepted for the course the fees required
will be paid to the University before or on the date of registration.
Name…………………………………………Signature ………………………………………….
Position………………………………………………………………………………………………
Relationship……………………………………Date……………………………………………...
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Full-Time Application Form 2023-2024 Intake
FORM AC 01A
PART IV
Signed…………………………………………………….Position……………………Date…………..
This form must be returned, before the closing date/deadline indicated in the
advertisement to:
The Registrar – Admissions Office
Mulungushi University
P O Box 80415
KABWE
ZAMBIA
Cell.0977134107/0979310324/0977512687/0971507759
Email: [email protected] or [email protected]