APPLICATION FORM
REQUIEMENTS
1. Be 18 years and above
2. Hold O' level certificate with good passes in English, Mathematics, Physics, Chemistry and Biology
3. Identity card
4. Recommendation from the former school
5. Recommendation from the local religious leader
7. Recommendation from the L.C.! Chairman
8. Birth Certificate
9. Two (2) passport size photos
10. Original U.C.E Slip and certificate
11.Interview fee: 50,000 ugx

The Form Below MUST be filled and submited

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Course Applied for: *
Required
First Name *
Other Names *
Age *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Required
Marital Status *
Required
Contact
Parents
Name of the Father *
Father's Contact *
Name of the mother *
Mother's contact *
Home Address
Village *
Parish *
Sub county *
County *
District *
Religion *
Education Standard
O'level School attended *
O'level Results
English *
Maths *
Physics *
Chemistry *
Biology *
A level and results if any
Place of work
Give two reasons for choosing to train as a nurse/ midwife *
Who will be responsible for your tuition?
Name: *
Relationship
Source of his / her income
Referees ( important people who are prepared to give you reference (not relatives) and their contact. *
Declaration
I, the undersigned, to the best of my understanding, declare that the information given above is true
Name of Applicant *
Signature/ Initials *
Date *
MM
/
DD
/
YYYY
Submit
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