MINISTRY OF TECHNOLOGY AND SCIENCE

KABWE INSTITUTE OF TECHNOLOGY

in
Association with
KWAME NKRUMAH UNIVERSITY
P.O. BOX 80430, KABWE. Call us: 0977 143641, 0968 989828, 0977759307, 0977928310

STUDENT APPLICATION FORM (EDUCATION): JANUARY, 2023

Surname…………………………………………………………….. Other Names…………………………………………………………………
NRC No:………………………………………………………………...Gender…………………………………………………………………………
Date of Birth………………………………………………………….. Grade Completed……………………………………………………….
Contact Address………………………………………………………Residential Address……………………………………………………..
Email Address………………………………………Year of Completion………………………Telephone/Cell No……………………
Sponsorship: self/Family/Employer/Sponsor’s Name:……………………………………………………………………….
Postal Address…………………………………………………………Residential Address……………………………………...................
Email Address:………………………………………………………………………………………………………………………………………………
Other Qualifications (if any)………………………………………………………………………………………………………………………..

NB. Please note that certified Photostat copy/copies of certificates/statement of results & NRC must be
attached to the Application Form

BLANK SPACES CAN BE USED FOR SUBJECTS NOT SHOWN

Insert
Principles of Accounts
Literature in English

Religious Education

Grades
Agriculture Science

Zambian Language
Technical drawing

Metal/woodwork

Home Economics
English Language

General Science

Passed
Civic education
Mathematics

Combined Sc

at Grade
Geography

Commerce
chemistry

12 (Form
Biology
Physics

History

music
techn

V)
Art
a

Grades:

Education Course :

Subject Combination:

Mode of Training: Full Time/Part Time/Distance Learning

Candidate’s Signature ……………………………………………………….. Date ……………………………………………………

Student Affairs Officer’s Signature………………………………....... Date…………………………………………………..