MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES For Offial Use Only

For Offial Use Only
Affix tw o
stamp size
photographs
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
APPLICATION FORM FOR SECOND SELECTION TO ORDINARY DIPLOMA PROGRAMMES FOR THE ACADEMIC YEAR
2014/2015 EVENING OR EXECUTIVE TRACK
EVENING OR EXECUTIVE TRACK
Three filled copies of this form together with copies of school certificates be sent to: Director, Undergraduate
Education/Admissions Office, P.O. Box 65001, Dar es Salaam, Tanzania: due@muhas.ac.tz
(Please read carefully the Instructions to Applicants attached before filling in this application form)
CHOICE OF PROGRAMMES IN DESCENDING ORDER OF PREFERENCE
In the table below, enter the programmes you would like to study in order of preference. Details of the
programmes are given in the Instructions to Applicants.
Choice
Programme
Full Name of Programme
Specialization (when
Code
applicable)
First Choice
Second Choice
Third Choice
1.0
1.1
1.2
1.4
1.6
1.8
1.9
1.10
PERSONAL PARTICULARS
Surname (Block Letters): ......................................................................................................................................
First Name: …………………………………..………
Middle Names: .....................................................
(Note: The names entered in this form must be exactly the same as those appearing on your A.C.S.E.E.Form VI or other certificates to be used for admission.)
Sex: Male [ ]
Female [ ]
1.3 Date of Birth: ...................................................................
Place of Birth…………………………
1.5 Citizenship: ……………………………….………………….
Religion: ……………………………..
1.7 Marital Status: ..................................................................
Mailing Address: P.O. Box…………………………………………………………………………………...……..………….
Telephone Number(s): .............................................. e-mail: ....................................................................................
Do you have any kind of disability? Yes: [ ]
No: [ ] If yes, specify…………………………………………..
(Note: This Information is required in order for the University to arrange appropriate means of assisting you once
admitted. It will in no way affect the decision to admit you)
2.0
2.1
EDUCATION BACKGROUND AND EMPLOYMENT RECORD
Certificate of Secondary Education Examinations (C.S.E.E.)/National Form IV/or Equivalent.
Subject
Grade
Year
Index No
Subject
Grade
Year
Examination Authority .................................................................
Examination Centre or School: .....................................................
Index No
Division: ....................................................................
Country: ..................................................................
Address of the School you attended last: Tel. No:…………………………………….email address…………………….……
Postal Address……………………………………………………………………………………………………………………………...
2.2 Advanced Certificate of Secondary Education (A.C.S.E.E.)/National Form VI or equivalent.
Subject
Grade
Year
Index No
Subject
Grade Year
Examination Authority ...................................................................
Examination Centre or School: .......................................................
Index No
Division: ..................................................................
Country: .................................................................
Address of the School you attended last: Tel. No:…………………………………….email address…………………….……
Postal Address…………………………………………………………………………………………...
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
Admissions Office, P.O. Box 65001, Dar es Salaam, Tanzania
Instructions to applicants seeking admission to Ordinary Diploma in Evening or
Executive Track
Applicants are required to read these instructions carefully before filling in the
application forms. Incorrectly filled or incomplete application forms will not be
processed.
1.0
APPLICATION FEES
Submission of duly filled application forms should be accompanied with
payment of non-refundable Application fee.
The application fee for
Tanzanians is TShs. 20,000/= and for non-Tanzanians is USD 30. All payments
should be deposited into the MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED
SCIENCES, NATIONAL MICROFINANCE BANK OF TANZANIA LIMITED (NMB)
ACCOUNT NUMBER 2091100002 (MUHIMBILI BRANCH). Remember to use the
applicant’s name and make sure that you attach to your application forms a
copy of our receipt which you will obtain at our Bursar’s office after
presentation to him the original pay-in slip of the application fee. Applicants
are advised to keep a copy of the receipt and pay-in slip for future use
whenever required.
2.0
ORDINARY DIPLOMA PROGRAMMES
The programme offered by MUHAS under Ordinary Diploma Executive Track
includes;
1. DIPLOMA IN MEDICAL LABORATORY SCIENCES (3 YEARS)
2. DIPLOMA IN ENVIRONMENTAL HEALTH SCIENCES (3 YEARS)
3. DIPLOMA IN DIAGNOSTIC RADIOGRAPHY (3 YEARS)
4. DIPLOMA IN PHARMACEUTICAL SCIENCES (3 YEARS)
5. DIPLOMA IN NURSING (3 YEARS)
3.0
SUBMISSION OF APPLICATION FORMS
Duly filled application forms should be handed in to the Admissions Office,
Muhimbili University. Application forms may also be posted to:
Director, Undergraduate Education,
Admissions Officer,
P.O. Box 65001,
Dar es Salaam, Tanzania.
The deadline for submission of duly filled application forms is 4 p.m. on Friday
31st October, 2014. Application forms received thereafter (whether submitted
in person or otherwise) shall not be processed.
4.0
WARNING
It should be noted that it is an offence to submit false information when
applying for admission. Applicants who will be discovered to have submitted
forged certificates or any other such information will not be considered and
appropriate legal action will be taken against them. Bonafide University
students are cautioned not to attempt applying for admission. If such students
submit their applications then they will be liable to de-registration from studies.
Likewise, former students who have already graduated cannot be admitted as
undergraduate students under Government loan sponsorship.
5.0
FINAL CHECKLIST OF APPLICATION FOR ADMISSION
Since incomplete application forms will not be processed, it is important that
the applicant checks whether three sets of application forms are made and all
the items indicated below are included in her/his application submission.
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Four stamp size black and white photographs with applicant’s name
written at the back
Three copies of certificates and/or result slips for O-Level or equivalent
Three copies of certificates and/or result slips for A-Level or equivalent
Three copies of Birth Certificate and/or Affidavit
The original bank pay-in slip for the payment of the non-refundable
Application fees.
A letter of commitment from your sponsors indicating his/her
commitment on paying the required fees and other related payment to
the University
N.B Accommodation facilities will not be provided to all Executive track
programme. The successfully selected candidates will have to make their own
accommodation arrangements.