Maims

Fill in your details in the form below to apply

(Part 1) Personal Details

Enter Full Name

Enter NRC/Passport #

Select Gender

Enter Date of birth

Select Marital Status

Select Nationality

Enter Your Physical Address

Enter Your Email Address

Enter Your Phone Number

(Part 2) Program Details

Select Program Under

Select Mode of Study

Select Level of Study

First Choose Program

Select Intake you are applying for

(Part 3) Experience Details/CV Optional

Enter Last Institution of Learning Attended

Enter Highest Qualification

(Part 4) Details of Parent/Guardian or Next of Kin

Parent/Guardian Full Name

Parent/Guardian NRC/Passport #

Select Parent/Guardian Gender

Parent/Guardian Date of birth

Select Parent/Guardian Nationality

Enter Parent/Guardian Physical Address

Enter Parent/Guardian Email Address (Optional)

Enter Parent/Guardian Phone Number

Whats the Relationship?

(Part 5) Kindly type your essay

(Part 5) Attachments

Attach Certified Grade 12 Certificate/Other Certificates/Statement of Results Attach NRC/Passport/Drivers Lincense Attach proof of payment for application fee

Declaration:

I hereby declare that the information l have provided in this application is to the best of my knowledge correct and complete.
I declare that all documents supplied with this application are legal and not fraudulently obtained.
I further declare that in the event that my application for enrolment as a student at the college is accepted, l will be bound by the provisions of the relevant student rules and regulations that are in force at the college.
I declare that lam able to meet tuition fees, accommodation charges and other costs while studying at the college.
I do hereby understand that the application fee is non-refundable and that my application will not be processed without this fee.
I declare that signing this application form and declaration l fully understand and agree with the above stipulations.

I agree to comply with all

APPLICATION FEE: A non refundable application fee of K150 must be made to following:

Bank Name: Access
Account Name: Chipata College Of Nursing and midwifery
Account No: 0080840581008
Branch: Chipata