Kitwe College of Education

Transcription

Kitwe College of Education
Attach a Passport
photo
Kitwe College of Education
Application for admission to Primary Teachers’ Diploma by Distance
This form should be completed and returned along with supporting documentation as required to the
Directorate of Open and Distance Education, Kitwe College of Education, P.O. Box 22596, Kitwe, Zambia.
Please complete this form in block capitals or type
PERSONAL DETAILS
1. Mr./Mrs./Ms ………………………………………………………………………………………………………………………………………
Surname (Last Name)
2. Other Names ………………………………………………………………………………………………………………………………………
First Name/Middle Names
3. Nationality ……………………………………………………… Sex: Male/Female…………………………………………………..
4. National Registration card Number/Passport number ………………………………………………………………………..
5. Place of birth ……………………………………………………………. Date of Birth ………………………………………………….
6. Marital Status: Married/ Single/Divorced/ Widowed …………………………………………………………………………
7. Number of children ……………………………………………………………………………………………………………………………
8. Permanent home address:
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………..
9. Postal Address
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………..
1|Page
10. Email address ……………………………………………………………………………………………………………………………………..
11. Tel/Mobile phone number ………………………………………………………………………………………………………………….
SECTION B NEXT OF KIN
12. Name of next of kin ……………………………………………………………………………………………………………………………
13. Address of next of kin …………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
14. Tel/Mobile number ……………………………………………………………………………………………………………………………
15. Relationship to the applicant ……………………………………………………………………………………………………………..
SECTION C EDUCATION AND QUALIFICATION
16. Further Education (college)
Give details of higher education since leaving secondary school. Please provide information on
qualification already obtained and examinations still to be taken.
Name of institution
Dates (month –year of
attendance)
Qualification (include class or grade a
obtained if known)
2|Page
N.B Photocopies of all certificates and course transcripts awarded for these qualifications must be
attached to this application. International students are requested to provide official copies of their entire
course transcript including explanations of the mark scheme used where possible.
17. Secondary school
Last school attended …………………………………………………………………………………………………………………………
Name of School
Subjects written
Corresponding
grades obtained
Examining body
SECTION D EMPLOYMENT
18. Present Employment………………………………………………………………………………………………………………………….
Employer…………………………………………………………………………………………………………………………………………….
Date of employment…………………………………………………………………………………………………………………………..
Nature of Employment (give details)………………….………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
3|Page
19. Previous employment (List under the following headings):
Date(s)
Employer
From:
To:
………………………………………………………….
….. ……………………….
Nature of Employment
. ………………………………………….
………………………………………………………….
….. ……………………….
. …………………………………………
…………………………………… …………………….
….. ……………………….
.. ………………………………………..
SECTION E FINANCIES
20. If you are admitted to the programme,
Name of the sponsor …………………………………………………………………………………………………………………………
SECTION E ADMISSION REQUIREMENTS
21. Payment of K100, 000.00 non-refundable application fee and depositing the other fees in the college
KTC project Account No. 0450220002827, ZANACO OBOTE BRANCH KITWE. No cash payment.
22. Possessing a Primary Teachers’ Certificate or Pre-school teachers certificate
23. A school certificate with 5 O levels, English, Mathematics and science inclusive.
I have read the conditions set above and I totally agreed to them. I further declare that the information
supplied in this form is correct and fully understand the implications outlined for my admission.
……………………………………………………………………….
……………………………………………………………
Signature of Applicant
Date
4|Page
FOR OFFICIAL USE ONLY
Signature of Officer making entry ………..……………………………………………………………………………………………………
Date of receipt of Application…………………………. ……………………………………………………………………………………….
Date receipt Acknowledged…………………………… …………………………………………………………………………………………
Result of Application………………………………….. ……………………………………………………………………………………………
Receipt No. of Application Fee……………………….. ……………………………………………………………………………………….
………………………………………………………… ……………………………………………………………………………………………………..
5|Page