UNIVERSITY OF CAPE

COAST AFFIX
PHOTOGRAPH

APPLICATION FOR ADMISSION TO FIRST DEGREE PROGRAMMES

SPECIAL TRANSFER FORM

i. A copy each of certified academic transcript(s) and photocopies of certificate(s)/results slip(s) should
accompany the application.
ii. Three (3) recent passport-sized photographs should be provided. Two of the photographs should be affixed
on the spaces provided. The last picture should be endorsed by the person who endorsed the application
forms.
iii. The Application for Admission Forms should be completed in duplicate. Applicants are advised to provide
a correct and current address which would speed up correspondence between the University and the
applicants.

PERSONAL DETAILS:
1. Surname:…………………….…………………………..………………………….……………

2. First Name:…...………………………………………………….……….…………….………..

3. Middle Name(s):.…...…………………………………………………………………..……….
(Names must correspond exactly with those used for all examinations taken/on certificates)

4. Gender M F Date of Birth:………….……………………….……………

5. Place of Birth:………………………………………Nationality:……………………...………..
6. Home Town:………………..….…………... Region/State:……………………………………………...

7. Tel/Mobile #…………….……………………..…Email:………………………………………………..

8. Marital Status (1-Single 2-Married) Number of Children…………………..………

9. Religion:………………………………. Denomination:...……………..………………………
10. Address to which communication in respect of this application should be sent:
………………………………………………………………………..…………………………..
……………………………………………………………………..……………………………..
11. Permanent Home Address (Residence) if different from 10 above.
……………………………………………………………………………………..……………..
…………………………………………………………Tel #...…………………...…………….
12. Particulars of Parent/Guardian

Name:………………………………………………….…………………………………………………………....
 Address:…………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………..

Relationship to Applicant…………………………………………………………………..…………...………….

Tel/Mobile #:………………………………………………………..Email:………………………………………

13. EDUCATION
Secondary/High School(s) attended with dates:
Attendance Dates
Name of School & Location Particulars of offices held at school
From To

…………………………………………… ………... ………... ……………………………………………

…………………………………………… ………... ………... ……………………………………………

…………………………………………… ………... ………... ……………………………………………

…………………………………………… ………... ………... ……………………………………………

…………………………………………… ………... ………... ……………………………………………

14. Applicants are to state the Institution(s) attended. Enter all examinations taken in different
years with dates
INSTITUTION ATTENDED PROGRAMME YEAR OF EXAM & GRADES/CLASS

15. PROGRAMME:
………………………………………………………………………………………………...

16. Are you physically challenged? Yes/No.

If Yes, specify:…………………………………………..……………………………………….

……………………………………………………………………………………………………
17. If you have ever been admitted to this University or any other University institution, you must supply
the following information:
Name of University………………………………………………………………………….………………………

Year of Admission…………………………………………………………………………..………………………..
 Programme of Study………………………………………………………………………………………………….

Last Year in University……………………………………………………………………………….……………...

Reasons for Leaving…………………………………………………………………………………….……………

IMPORTANT: An applicant who makes a false statement or withholds relevant information may be
refused admission. if he/she has already come into the university, he/she may be asked to
withdraw.

Signature of Applicant……………………..………..………….. Date……….…..………………….

DECLARATION
This portion should be signed by someone of high repute who is expected to know the applicant officially/personally.
The application will not be valid if the declaration below is not signed. If the declaration proves to be false, the
application will be rejected; if the falsity is detected after admission, the student will be dismissed.
I certify that the photograph endorsed by me is the true likeness of the applicant

Mr./Miss/Mrs…...................................................................................is officially/personally known to me.

I have inspected his/her certificate(s) and I am satisfied that they are genuine and the name that appears on
them is the same as that by which he/she is officially/personally known to me.

Name……………………………………………………………………..……………………………………………….…

Status……………………………………………………………………………………………………………………...…

Address……………………………………………..……………………………………………………………..…………

…………………………………………………………………………..…………………………………………………...

Signature………………………..…………………….……….. Date……………...……………………………..

Note: All documents submitted in connection with this application become the property of this University.

 ATTACH A COPY OF YOUR DETAILED RESULT TO THIS APPLICATION