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Decohas. ac.tz E-mail decohas gmail.com Mob 255 717 514324/ 255 767 832211 STUDENT APPLICATION FORM Attach three colored passport Carefully read the Instructions to Applicants before filling in this application form. This form can be typed or handwritten size photos Academic Year for which admission is sought e.g. 2014/2016. DECCA COLLEGE OF HEALTH AND ALLIED SCIENCES DECOHAS P. O. Box 372 Dodoma Tanzania* Cell 255 767 182 106 Tel/Fax 255 26 2322357 Website www. CHOICE OF CERTIFICATE DIPLOMA PROGRAMMES IN DESCENDING ORDER OF PREFERENCE In the table below enter the Certificate and/or Diploma Programme you would like to study in descending order of preference. Details of the Certificate Diploma Programmes are given in the Instructions to Applicants. Choice of programme First choice Second choice Third choice Section 1 Department Full Name of Programme as Indicated in the 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 Permanent Home Address Address for Correspondence If different from Home Address City Country Telephone Page 1 of 3 Please write your e-mail address clearly Email Education Details your qualifications must demonstrate eligibility for the course complete in BLOCK letters or type 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. on Exam date Employment Details 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 Address Accommodation Position held tick if you need accommodation YES NO 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 Savings Other Job Title Loan 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 Referees Please provide the names of two referees at least one should be an academic referee who has knowledge of your academic ability. CHOICE OF CERTIFICATE DIPLOMA PROGRAMMES IN DESCENDING ORDER OF PREFERENCE In the table below enter the Certificate and/or Diploma Programme you would like to study in descending order of preference. Details of the Certificate Diploma Programmes are given in the Instructions to Applicants. Choice of programme First choice Second choice Third choice Section 1 Department Full Name of Programme as Indicated in the 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 Permanent Home Address Address for Correspondence If different from Home Address City Country Telephone Page 1 of 3 Please write your e-mail address clearly Email Education Details your qualifications must demonstrate eligibility for the course complete in BLOCK letters or type List all academic qualifications that you have achieved O A level grade or equivalent.