JJUNGO SENIOR SECONDARY

SCHOOL
Applicant’s
P.O.BOX 11165 KAMPALA Photograph
+25677241643 / +256705081626
jjungoss22@gmail.com
A-LEVEL APPLICATION FORM
Part A: Personal Information
a) Surname (Block letters): …………………………………………………………………………………………………………...

b) Middle name (if applicable, Block letters): …...………………………………………………………………………………..

c) First name (Block Letters): ………………………………………………………………………………………………………...

Gender ……………………….Religion………………………………………..
d) Date of Birth
d) Learner Identification Number
e) Learner National Identification Number (if available)

Part B: Educational Information

Uganda Certificate of Education (U.C.E)

a) Index number: Year of examination:

b) Name of school: …………………………………………………………………………………………………………………….

Subject Grade Subject Grade Aggregates

English Geography Division
Mathematics History Combination

Chemistry

Biology
Subsidiary
Physics

Part C: Parent / Guardian details Information

Are you an orphan………………………State which parent if ……………………………………...……………...
Type Please tick Father /Guardian Please tick Mother /Guardian

Surname

First name

Relationship

Nationality

NIN number

Telephone No.

Place of Residence
DECLARATION
I hereby declare that all the above information is correct and accurate to the best of my knowledge.
Applicant’s Name:

Applicant’s Signature:

Date:

Love Wisdom
Love Wisdom
We build for the future
 JJUNGO SENIOR SECONDARY
SCHOOL
Applicant’s
P.O.BOX 11165 KAMPALA Photograph
+25677241643 / +256705081626
jjungoss22@gmail.com
A-LEVEL MEDICAL FORM
Section A : Personal Information
a) Surname (Block letters): …………………………………………………………………………………………………………...

b) Middle name (if applicable, Block letters): …...………………………………………………………………………………..

c) First name (Block Letters): ………………………………………………………………………………………………………...

c) Gender ………………………………...Class……………………………… Age………………………………………………….

d) Date of Examination

Section B : Examination
Any serious medical problems in the past

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General report

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Any treatment required

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Optician Report
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Dental Report

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Examining Doctor’s Name:…………………………………………………….Signature:……………………………………….

Hospital stamp

Love Wisdom
 JJUNGO SENIOR SECONDARY
SCHOOL
Applicant’s
P.O.BOX 11165 KAMPALA Photograph
+25677241643 / +256705081626
jjungoss22@gmail.com
A-LEVEL DECLARATION FORM
This form should be returned to school on the reporting day
after the parent and the student have read and understood
the school rules and regulations.
I………………………………………………………………..the Parent /
Guardian of ……………………………………………………………………
( Student / Class) declare that we have read and discussed the
consequences of the school rules and regulations in case of
misconduct.
……………………………………… ………………………………………
Student Name signature
……………………………………….. ……………………………………...
Parent’s Name signature

Date……………………………………………..

Love Wisdom