Student Bio Data Form - Entebe Secondary School

ENTEBE SECONDARY SCHOOL

P.O.BOX 206 ENTEBBE

0414 323 266

ebbsecsch03@yahoo.co.uk

entebbessat50@gmail.com

A-LEVEL STUDENT BIO DATA FORM - SENIOR FIVE

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Part A: Personal Information

Surname:

Middle Name:

First Name:

Date of Birth:

Gender:

Religion:

Learner Identification Number:

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
Mathematics
English
Science
Social Studies

O-Level Results
Total Aggregates
Division

Subject	Grade
English
Mathematics
Chemistry
Biology
Physics

Subject	Grade
Geography
History

Aggregates
Division
Combination
Subsidiary

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

I declare that all information provided above is accurate and submitted to the best of my knowledge.

Student's Signature:

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