Form number /TC/OD/UG:________
KILIMANJARO SCHOOL OF PHARMACY
P.O. BOX 481, MOSHI
TEL/FAX +255272752303
E-MAIL:
[email protected] or
[email protected] APPLICATION FORM FOR ADMISSION TO PHARMACEUTICAL SCIENCES PROGRAMMES
ACADEMIC YEAR 2019/2020
APPLICATION GENERAL INSTRUCTIONS:
A. READ CAREFULLY instructions given in EACH section of this Application Form. Any Form
THAT is not filled well WILL NOT BE PROCESSED.
B. ATTACHMENTS
This filled application form should be accompanied with the following documents
2.1. Original Bank –Paying slip of non-refundable application fee of TSH, 30,000/= (Thirty
thousand shillings only) payable to:-
Account Name: Saint Luke Foundation:
Account Number: 01J1039647000 CRDB bank
2.2. A copy of form Four Certificate of Secondary education examination (O-level) and any other
recent relevant (see C below) academic certificate if any (e.g. A –level certificate,)
2.3. A copy of Birth certificate
2.4. Written Application letter
C. ELIGIBILITY FOR APPLICATION
2.5 Holders of Certificates of Secondary Education Examination (CSEE) with Four (4) Passes in
Non-religious subjects including “D” passes in Chemistry and Biology.
2.6. All holders of Technician Certificates/Upgraders/In-service obtained from recognized
colleges
SEE DESCRIPTIVE SUMMARY OF ELIGIBILITY BELOW IN THE TABLE
PROGRAM NAME ADDMISSION REQUIREMENT
TECHNICIAN CERTIFICATE IN Holders of Certificate of Secondary Education Examination (CSEE)
PHARMACEUTICAL SCIENCES with four (4) Passes in non-religious Subjects including "D" Passes in
Chemistry and Biology; AND Possession of Basic Technician
Certificate (NTA Level 4) in Pharmaceutical Sciences
ORDINARY DIPLOMA IN Holders of Certificate of Secondary Education Examination (CSEE)
PHARMACEUTICAL SCIENCES with four (4) Passes in non-religious Subjects including "D" Passes in
Chemistry and Biology, a Pass in Basic Mathematics and English
Language is an added advantage.
ORDINARY DIPLOMA IN Holders of Certificate of Secondary Education Examination (CSEE)
PHARMACEUTICAL SCIENCES with four (4) Passes in non-religious Subjects including "D" Passes in
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(UPGRADING) Chemistry and Biology, a Pass in Basic Mathematics and English
Language is an added advantage AND must possess Technician
Certificate (NTA Level 5) in Pharmaceutical Sciences
D. No application will be considered/processed for selection if, it is not accompanied with the
above-mentioned documents.
E. The deadline for submitting your application is Friday, 31st July, 2019
1. APPLICANT’S PERSONAL PARTICULARS:
Instruction: Write in Capital/BLOCK LETTERS and Provide Valid information to avoid Misleading
1.1 First Name:
1.2 Middle name:
1.3 Surname:
1.4 Gender: (Male or Female)
1.5 Date of Birth(day, month, year)
1.6 Nationality:
1.7 Region and district of residence:
1.8 Marital Status: (Single or Married)
1.9 Applicant Mobile Telephone number:
1.10 Parents/Sponsor Phone Numbers
1.11 Applicant E-mail address:
1.12 Parent/sponsor email address:
1.13 Home or Permanent Physical Address
i.e. Applicant and Parents P.O BOX
2. EDUCATIONAL QUALIFICATION ATTAINED RELEVANT TO THIS COURSE
Instruction: Attach copies of relevant certificates
Class and Certificate Year Name of secondary
Division/score Index of school or Institution
/Results number Award
2.1 Form Four (O-Level) certificate of
secondary education (CSEE) or any
other
2.2 Advanced certificate of Secondary
education (A-level) if any
2.3 Any other type of courses attended
and their award (e.g. Certificate,
Diploma)
2.4 Name of Primary School Attended
(Standard Seven education)
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3. 1.Details of work experience (for in-service programme only)
Date Employer Position Nature of Work
3.2. Briefly describe/list your daily responsibilities
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________________________________
4. Do you have Physical or any disability which might necessitate special arrangements or facilities - YES/NO
If YES it would be helpful if you could forward to us further details of your disability and special requirements.
I certify that the information given above is correct
Signature of applicant: _____________________________ Date________________________
5. Name of the Sponsor/Parent(s) and Commitment:
I ________________________________________ certify that the qualifications declared by the applicant
are correct and have seen original certificates. I commit to pay the fees and other costs of the applicant if
admitted to the course:
Signature of Sponsor/Parent_________________________________ Date: ______________________
6. When completed filled, return this form to:
Principal
Kilimanjaro School of Pharmacy
P.O.Box 481 - Moshi
Mob: 255763243952, 255621 90 54 54, 255688 10 60 76
Tel: 255 27-27 52303
email:[email protected], [email protected]
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