STUDENT APPLICATION FORM
ADM. NO: _________________________
TWO PHOTOS
Please provide all the necessary information and read the important notice
at the end of this form. You are also required to submit certified copies of
relevant academic certificates with this application form.
1. APPLICANT DETAILS
Surname: ___________________________ First name: __________________________
Middle name: _______________________
**Please write names as they appear in your academic certificates.
Gender: ……………..
Date of Birth (year)…………. (Month)………… (Day)………. Marital Status ……………………
Permanent Address: …………………………………………………………………………………………………
Contact Tel: ……………………………….……………… E-Mail …………………………………………………
Occupation: ……………………………………………….
Name and address of the person to be notified in case of emergency (Next of kin)
Name……………………………………………….
Address………………………………………...
Telephone number……………………………… Email address: ………….……………………...
Relationship: …………………………………………………
2. COURSE SELECTION
(Please choose only three courses, starting with your first choice)
LONG COURSES
Course level (Diploma/NACTE Certificate/VETA Certificate)……………………………………
1. INFORMATION TECHNOLOGY
2. BUSINESS ADMINISTRATION
3. PROCUREMENT AND SUPPLY
4. ACCOUNTING
5. FRONT OFFICE
6. HOTEL MANAGEMENT
SHORT COURSES
1. COMPUTER APPLICATION
2. ICT FOR BEGINNERS
3. CISCO (CCNA/CCNP)
4. MICROSOFT (MCSE/MCITP)
5. ACCOUNTING PACKAGE
6. WEBSITE DESIGN
7. GRAPHICS & DESIGN
8. VIDEO PRODUCTION
9. OTHERS (Please specify) …………………………………………………………..
3. TYPE OF SPONSORSHIP
Government Private Company
Organization
Name, address and telephone number of the sponsor
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
Do you have any physical or communication disabilities?
Note: Information about your disability will not
jeopardize your chances of being selected
Yes. No.
If yes, please provide details below;
………………………………………………………………………………………………………………………………
Have you ever been convicted of a Criminal Offense?
Yes. No.
If yes, please provide details below;
………………………………………………………………………………………………………………………………
4. EDUCATION BACK GROUND
LEVEL DURATION SCHOOL/COLLEGE AWARD RECEIVED
From – To UNIVERSITY
UNIVERSITY -
COLLEGE -
A – LEVEL -
O – LEVEL -
PRIMARY -
4. WORKING EXPERIENCE
DURATION ORGANISATION,COMPANY POST HELD
From – To INSTITUTION
_
_
_
IMPORTANT NOTE
1. Affix your photograph taken within the last 6 months.
2. Attach a certified true copy of academic certificates, transcripts and birth certificate.
3. The application Form should be sent to your first priority to the address above with
a non-refundable fee of Tsh 10,000 /=
4. If you are an employee pass the application to your employer if possible.
5. Tuition fees once paid cannot be refunded or transferred under any circumstances
5. APPLICANT DECLARATION
I declare that all information given are true and correct, And accept all the terms and conditions,
ready to follow all the rules and regulations as per institute’s policy.
Applicant signature ……………………………………. Date: ____/_____/202_
THE MANAGEMENT OF THE KILIMANJARO INSTITUTE OF
TECHNOLOGY AND MANAGEMENT, WELCOMES YOU TO ENJOY
THE SPIRIT OF TECHNICAL AND VOCATIONAL EDUCATION
PAYMENTS DETAILS:
1. Bank Name: EXIM BANK (T) LIMITED
Name of Account: THE KILIMANJARO INSTITUTE OF TECHNOLOGY
AND MANAGEMENT
Account Number: 0010048717
2. Bank Name: NATIONAL MICROFINANCE BANK (NMB) BANK
Name of Account: THE KILIMANJARO INSTITUTE OF TECHNOLOGY
AND MANAGEMENT
Account Number: 22210007139
M-Pesa 5694377
FOR OFFICIAL USE ONLY
Date of receipt
Application fees receipt no
Amount
Received by (Name and Signature)
