pharmacy dispensing nta level 4 2015/2016

DECCA COLLEGE OF HEALTH AND ALLIED SCIENCES
(DECOHAS)
P. O. Box 372, CCT, Dodoma – Tanzania
Tel/Fax: +255 26 2322357, Mob: +255 767 832211/+255 655 407282
Website: www.decohas.ac.tz, E-mail: dpfa@decohas.ac.tz, info@decohas.ac.tz
Attach
three
colored
passport
PHARMACY DISPENSING NTA LEVEL 4
size
photos
STUDENT APPLICATION FORM
(Carefully read the ‘Instructions to Applicants’ before filling in this application form.
This form can be typed or handwritten)
Academic Year for which admission is sought (e.g. 2015/2016): ……………………………………………………….
BASIC CERTIFICATE IN PHARMACY DISPENSING ONE YEAR COURSE
In the table below, enter the Programme you would like to study. Details of the Certificate Programmes
are given in the “Instructions to Applicants”.
Choice of
programme
NTA LEVEL 4
Section 1:
Department
Programme
Full Name of Programme
Applicant Details
(Please complete in BLOCK letters or typed)
Last Name
First Name
Middle name
Date of Birth
Gender
Nationality
Male
Female
Marital Status
Do you consider yourself to have a
disability?
Yes
No
Single
Married
No. of
Children
Do you have a criminal
conviction?
Yes
Permanent Home Address
Address for Correspondence (If different from Home
Address)
City
City
Country
Country
Telephone
Telephone
Email
No
Please write your e-mail address clearly
Page 1 of 4
Education Details (your qualifications must demonstrate eligibility for the course,
complete in BLOCK letters or type)
Section 2:
List all academic qualifications that you have achieved “O”, “A” level grade or equivalent. Copies of all
relevant final transcripts must be attached with this application.
Qualification
From
To
School / College/ University name
Grade / %
Marks
List any results you are awaiting and including anticipated grades.
Qualification/course/examinati
on
Section 3:
Exam date
Employment Details:
School /College/University name
Expected
grade
(Important if you are applying as a mature age entry).
Please give details of positions held over the past 5 years, if you are applying as a mature – age or for
admission as a post graduate, provide detailed job descriptions on separate page and attach
documentary evidence, e.g. reference letters from employers.
Employer name
Section 4:
Address
Accommodation
Position held
From
(tick √ if you need accommodation)
To
YES
NO
N.B: All residents are required to sign an accommodation tenant agreement form /contract before
allocated to the room. In a room you will find a bed, mattress and keys
Section 5: Finance
Indicate how you intend to finance your studies and your living expenses in Dodoma.
How will you finance your studies at DECOHAS? Family
Employer
Parents/Guardians
Job Title
Telephone No.
E-mail
Loan
Savings
Other
Page 2 of 4
Sponsor Declaration: I have agreed to finance the above named applicant in his/her studies at
DECOHAS and agreed to release funds for tuition fees and living expenses as and when required.
Signed: __________________________ Name __________________________ Date: ___________
Section 6:
References
(Please compete in BLOCK letters or type).
Please provide the names of two referees; at least one should be an academic referee who has
knowledge of your academic ability.
Referee name
Address
Telephone
E-mail
Section 7: Fee Structure
All payments shall be paid to DECOHAS Bank accounts at CRDB Bank Plc
Tuition fee: DECOHAS Tuition, Account No. 0150222135400
Other payments: DECOHAS Miscellaneous, Account No. 0150222135500
Bring bank pay - in slips to the college.
The fees are payable in full or in two installments at the beginning of each academic year /
semester.
Upon Return of this form, bring the pay-in slip of the application fee of Tshs 30,000/= Paid
to DECOHAS Miscellaneous, Account No. 0150222135500
Note: All payments other than Tuition fees should be paid to the DECOHAS Miscellaneous
Account number stated above
Application should be done directly to the College
Principal,
DECCA College of Health and Allied Sciences (DECOHAS)
P. O. Box 372,
Dodoma
Tel/Fax: +255 26 2322357,
Mob: 0767 182 106, 0717 514 324, 0767 832, 211, 0786 407 282
Website: www.decohas.ac.tz E-mail: decohas@gmail.com
Page 3 of 4
A: Tuition fee
Per annum
Tshs,800,000/=
B: Other Charges/Payments
DESCRIPTION
Registration fee per semester
Pharmacy Council Exams Fees
NACTE Quality Assurance Fee
Accommodation per annum
Medical fee per annum
Practicum Guide & Field attachment fee
Examination fee per semester
Caution money (paid once)
Identity Card (paid once)
Students Union (DECOHASSO) Fee per
annum
Meals
Total cost to College
DAY (TSHS)
10,000
150,000
15,000
0
60,000
160,000
50,000
100,000
10,000
HOSTEL (TSHS)
10,000
150,000
15,000
400,000
60,000
160,000
50,000
100,000
10,000
10,000
10,000
0
565,000.
1,500,000
2,465,000
Page 4 of 4