Mumsa High School Mityana A-Level Online Registration Form

Section A: Personal Information

Student's Name: Sex: Male Female Date of Birth: Home District: Religion: Nationality:

Section B: Student's Performance

Previous School Attended: Address: Where did you sit UCE?:

UCE Examination Results:

Section C: A-Level Subject Combination

Preferred Subject Combination: Select a combination Physics, Chemistry, Biology (PCB) Physics, Chemistry, Mathematics (PCM) Physics, Chemistry, Geography (PCG) Mathematics, Physics, Chemistry (MPC) Mathematics, Economics, Geography (MEG) History, Economics, Geography (HEG) History, Geography, Economics (HGE) Literature, CRE, English (LIT/CRE/ENG) Other (Specify in comments) UCE Index Number: In case you have a chronic disease, state it: Father's Name: Mother's Name: Contact Address: Email: Signature: