Attach Your

SCHOOL OF Recent
COMPUTING Photograph here

DEBRE BERHAN UNIVERSITY

OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2009 E.C/2016/167G.C ACADEMIC YEAR SCHOOL OF COMPUTING Faculty
INSTRUCTION: - Please read the instruction carefully.
I. This form is to be completed by the SCHOOL OF COMPUTING faculty students to be placed to one of
the following departments:-Computer Science, Information Technology and Information System, Software
Engineering
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------ ---------------------------- ----------------------------
First Name Father’s Name Grand father’s Name
ሥም በአማርኛ -------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age: ________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile) ______________________.
1.11 Date of Registration -------------- 1.12 Languages 1 st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first or
second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2 ------------------------------------- 3-------------------------------------------
4----------------------------------------
Certify that all the above information given is true and complete to the best of my knowledge. I fully realize
that omission or falsification of any information will be sufficient reason for the rejection of my application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
3.4 The grounds for the final placement of the students-------------------------------------------------------
3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------
3. --------------------------------- ------------------------- -------------------------
4. --------------------------------- ------------------------- -------------------------
GREADE 11 GREADE 12
AVERAGE
 ---- Attach Your
HEALTH Recent
Photograph
SCIENCE here

DEBRE BERHAN UNIVERSITY

OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2001 E.C/2008-9 ACADEMIC YEAR HEALTH SCIENCE Faculty
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the HEALTH SCIENCE faculty students to be placed to one of
the following departments:-NURSING, HEALTH OFFICER.
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------ ---------------------------- ----------------------------
First Name Father’s Name Grand father’s Name
ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORMATION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2 -------------------------------------
Certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
 3.4 The grounds for the final placement of the students-------------------------------------------------------
3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------
3. ---------------------------------
NATURAL AND ------------------------- -------------------------Attach Your
4. ---------------------------------
COMPUTATIONAL ------------------------- -------------------- Recent
Photograph
SCIENCE DEBRE BERHAN UNIVERSITY here
OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2001 E.C/2008-9 ACADEMIC YEAR NATURAL & COMPUTATIONAL SCIENCE Faculty
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the NATURAL & COMPUTATIONAL SCIENCE faculty students
to be placed to one of the following departments:-BIOLOGY, CHEMISTRY, MATHEMATICS
AND PHYSICS
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------ ---------------------------- ----------------------------
First Name Father’s Name Grand father’s Name
ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2. ------------------------------------- 3. ---------------------------4. --------------
certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
3.4 The grounds for the final placement of the students-------------------------------------------------
 3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- -------------------------
-------------------------
2. --------------------------------- -------------------------
--------------------------
3. --------------------------------- ------------------------- Attach Your
-------------------------
BUSINESS &
4. --------------------------------- ------------------------- Recent
-------------------------
Photograph
ECONOMICS here
DEBRE BERHAN UNIVERSITY
OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2001 E.C/2008-8 ACADEMIC YEAR BUSINESS & ECONOMICS Faculty
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the BUSINESS & ECONOMICS faculty students to be placed
to one of the following departments:-ACCOUNTING, ECONOMICS and MANAGEMENT.
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------ ---------------------------- ----------------------------
First Name Father’s Name Grand father’s Name
ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2 ------------------------------------- 3. ----------------------------------------
I certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
3.4 The grounds for the final placement of the students------------------------------------------------------
3.5 Checked by Decision making Committee (APC)
 Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------
3. --------------------------------- ------------------------- -------------------------
4. --------------------------------- ------------------------- ----------------------- Attach Your
Recent
ENGINEERING Photograph
DEBRE BERHAN UNIVERSITY here
OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2004 E.C/2012 G.C. ACADEMIC YEAR Engineering Program
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the Engineering program students to be placed to one of the following
departments: - Civil Engineering,Electrical Engineering, Construction &Technology Management, Chemical
Engineering, Mechanical Engineering.
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark (x) in the appropriate space. Use block (CAPITAL) letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------------------- ---------------------------- ------------------------- Section _____
First Name Father’s Name Grand father’s Name
ሙሉ ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1 st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify---------------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results obtained in
preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first or second
choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2 ------------------------------------- 3 -------------------------------------4
-------------------------------------5 -------------------------------------
I certify that all the above information given is true and complete to the best of my knowledge. If fully realize that
omission or falsification of any information will be sufficient reason for the rejection of my application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
3.4 The grounds for the final placement of the students
------------------------------------------------------------------------------------------
3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------
 3. --------------------------------- ------------------------- -------------------------
4. --------------------------------- ------------------------- -------------------------
5. ---------------------------------- ------------------------- --------------------------

HEALTH Attach Your

---
SCIENCE
-----------
Recent
Photograph
DEBRE BERHAN UNIVERSITY here
OFFICE OF THE REGISTRAR
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2001 E.C/2008-9 ACADEMIC YEAR HEALTH SCIENCE Faculty
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the HEALTH SCIENCE faculty students to be placed to one of
the following departments:-NURSING, HEALTH OFFICER.
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student
------------------------ ---------------------------- ----------------------------
First Name Father’s Name Grand father’s Name
ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2 -------------------------------------
I certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
------------------------------------ ---------------------------
Applicants’ Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
 3.4 The grounds for the final placement of the students
------------------------------------------------------------------------------------------
3.5 Checked by Decision making Committee(APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2.NATURAL &
--------------------------------- ------------------------- --------------------------
COMPUTATIONAL
3. --------------------------------- ------------------------- ------------------------- Attach Your
SCIENCE Recent
Photograph here
DEBRE BERHAN UNIVERSITY
STUDENTS’ ACADEMIC RECORD CENTRE
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2002 E.C/2009-10 ACADEMIC YEAR NATURAL & COMPUTATIONAL SCIENCE Program.
INSTRUCTION:- Please read the instruction carefully.
I. This form is to be completed by the natural & computational science Program students to be placed
to one of the following departments:-BIOLOGY, CHEMISTRY, MATHEMATICS & PHYSICS
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block /CAPITAL/ letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student

------------------------------------ ----------------------------------- -----------------------------------------

First Name Father’s Name Grand father’s Name

ሥም በአማርኛ --------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st ------------------ 2nd ---------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ---------------------------------- 2. ------------------------------------- 3. ---------------------------4. --------------
I certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
------------------------------------ ---------------------------
Applicant’s Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement -----------------------------------
 3.3 Final placement --------------------------------------------
3.4 The grounds for the final placement of the student
3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------

SOCIAL SCIENCE Attach Your

Recent
& HUMANITIES DEBRE BERHAN UNIVERSITY Photograph
STUDENTS’ ACADEMIC RECORD CENTRE here
NEW STUDENTS’ FIELD CHOICE APPLICATION FORM
2002 E.C/2009-10 ACADEMIC YEAR social science & humanities Program.
INSTRUCTION: - Please read the instruction carefully.
I. This form is to be completed by the SOCIAL SCIENCE & HUMANITIES program students to be placed
to one of the following departments:-GEOGRAPHY & ENVIRONMENTAL STUDY, AMHARIC,
HISTORY,PSYCHOLOGY,ENGLISH,CIVICS AND ETHICAL STUDY,
II. This application form should be completed by the applicant himself/herself.
III. Fill in the required information or mark(x) in the appropriate space. Use block /CAPITAL/ letters.
I. PERSONAL INFORMATION
1.1 Full Name of the student

------------------------------- --------------------------------- ------------------------------------

First Name Father’s Name Grand father’s Name

ሥም በአማርኛ ----------------------------------------------------------------------------------------
1.2 Sex: Male ( ) Female ( ) Age:________________
1.3 Date of Birth in E.C: Date ------------------ Month ---------------- Year ------------------
1.4 Date of Birth in G.C: Date ----------------- Month ---------------- Year -----------------
1.5 Place of Birth ---------------------- 1.6 Nationality ------------------ 1.7 Region----------------
1.8 Zone_____________________ 1.9 Woreda___________________ 1.10 Kebele____________
Your own Phone (Mobile)______________________.
1.11 Date of Registration -------------- 1.12 Languages 1st -------------- 2nd ------------- 3rd -------------
1.13 Any health Problem? Yes ------------- No -------------- If your answer is yes, Please
Specify-------------------------- & Attach medical Board Certificate.
1.14 Contact Person in Case of emergency: Name_________________________________
address_____________________________________________
1.15 Where did you come from? Urban ( ) Rural ( )
II. FIELD CHOICE
2.1 IMPORTANT INFORAMTION
i. Make sure that you have the attitude to join the field you have chosen.
ii. Your choice should mainly be based on your total mark scored in entrance Examination and results
obtained in preparatory program.
iii. Due to limited number of places and high competition in some fields, one might not get his/her first
or second choice. Please be advised to give due consideration to the choice you make.
1. ------------------------------------------------------------- 2 ------------------------------------ 3.
----------------4.----------------------------------------5.------------------------------------------
6.------------------------------------
I certify that all the above information given is true and complete to the best of my knowledge. I fully
realize that omission or falsification of any information will be sufficient reason for the rejection of my
application.
 ------------------------------------ ---------------------------
Applicant’s Signature Date
III. FOR THE PLACEMENT COMMITTEE ONLY
3.1 Entrance Examination (EHEECE) and results obtained in preparatory program total mark out of -----
3.2 Choice considered in the placement ----------------------
3.3 Final placement ----------------------------
3.4 The grounds for the final placement of the students-------------------------------------------------------
3.5 Checked by Decision making Committee (APC)
Name Signature Date
1. --------------------------------- ------------------------- -------------------------
2. --------------------------------- ------------------------- --------------------------