Transcript Application forms - St. Bakhita Health Training Institute

PREVENT
and
CURE
Diocesan Health Board
St. Bakhita Health Training Institute, P.O.BOX 17, Namanyere -Nkasi,
Rukwa - Tanzania E.A, Fax 025 283 0127 Tel 025 2830002/283 0044
[email protected], [email protected]
PASSPORT
SIZE
APPLICATION FORM FOR PRE-SERVICE AND IN SERVICE COURSES
ACADEMIC YEAR 2014/2015
Surname
Middle Name:
First Name:
Nationality:
Date of birth:
Place of birth:
Names
Sex:
Secondary Education (tick in appropriate
place):
Secondary school(s) attended:
Form IV:
Form IV:
Year:
Year:
“O” Level:
“A” Level:
Indicate grades scored for each subject: for
fresh from school
Tick the certificate level completed
Form IV: Biology:
Chemistry:
Basic Mathematics:
English:
Form VI: Biology:
Chemistry:
Certificate in Clinical medicine
Physics:
Physics:
(
)
Certificate in Nursing and Midwifery (
)
Course (Specify the course which you intend
to undertake) only one (See page 2):
Applicant’s postal address:
Applicant’s other contacts:
Parent’s/Guardian name and address:
Mobile No:
Fax No:
Telephone No:
E-mail Address:
Full Name:
Full Address:
INSTRUCTIONS TO ALL APPLICATIONS:
(a) None refundable Tshs 30,000 /= should be paid for each application form and for
entrance examination for certificate courses and Diploma courses will pay TSH 30,000/
for application only. The money should be deposited in the ST. BAKHITA NURSING
SCHOOL ACCOUNT NO. 6201100013 – NMB-NKASI BRANCH.
(b) Each application form is meant for one course.
(c) Attach the following:
(i)
One recently passport size photograph
(ii)
Original Bank pay-in slip
(iii)
Certified copies of Ordinary/Advanced secondary certificate, leaving Secondary
certificate
(iv)
Certified copies of completed courses in clinical medicine or certificate in nursing
and Midwifery
(d) Applicants completed their secondary school education outside the country should attach
their certificates and equivalent qualifications obtained from the national
Examination Council of Tanzania, for their academic certificates.
(e) The academic year will start on 1st October, 2014
List of course:
A. Certificate Course and Diploma courses
i.
Certificate in Medical Laboratory Technology
ii.
Certificate in Nursing and Midwifery
iii.
Diploma in clinical medicine pre-service NTA LEVEL 4-6
iv.
Diploma in clinical medicine in service NTA LEVEL 6
v.
Diploma in nursing pre-service
NTA LEVEL 4-6
vi.
Diploma in Nursing In service
NTA LEVEL 6
( 2 years )
( 2 years )
( 3 years )
( 1 Year )
( 3 Years )
( 1 year )
A. Certificate Course:
Applicant should have passes in Science subject with a minimum of “D” PASS in all
science subjects (Chemistry and Biology and Pass in Physics or mathematics) for
certificate in Nursing and midwifery are compulsory
B. Certificate in medical laboratory sciences , applicant should have passes in sciences
subjects with a minimum of “D” PASS in sciences subjects ( Chemistry and Biology
are compulsory and Physics or Mathematics or English
C. For Diploma Pre-service courses( in nursing and clinical medicine) – applicants
should have passes in science subjects for the pass of C in Biology, Chemistry and Pass
of D in physics or Mathematics for pre-service courses
D. For Diploma in- service courses ( in nursing and clinical medicine) – applicant should
have completed certificate courses in the respective area( certificate in clinical medicine
or certificate in nursing and midwifery NTA LEVEL 5).
Other requirements:
- Passes in Mathematics and English language is an added advantage
- Eligible applicants must have completed secondary education in Tanzania and sat for
NECTA.
Mode of Application:
All applications should be submitted to the,
DIRECTOR
St. Bakhita Health Training Institute,
P.O. Box 17,
Namanyere-Nkasi.
FOR MORE INFORMATION CALL,
0755354500, 0784890390,0767890390, 0689705050, 0755188484, 0787496496
Office number : 0252830044
DEADLINE FOR APPLICATIONS IS ON 25 August 2014 for Diploma courses
Entrance Examination will be conducted as here below.
Second interview for late applicants will be done on
1. 19/07/2014 for both Programs in certificate courses
Applicant’s Signature: ………………………………
Date: ……………………..……
Parent’s/Guardian Signature: ……………………...
Date: …………………………..
Sponsor’s Signature: …………………………………
Date: …………………………..