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APPLICATION form_Cert-Dipl_2015-16

This document is an application form for admission into certificate and diploma programs at Stella Maris Mtwara University College for the 2015/2016 academic year. It includes sections for personal particulars, emergency contact, education background, program choices, payment details, and required attachments. Applicants must submit the completed form along with a non-refundable application fee and necessary documents to the university's admission office.

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mkizag77
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22 views4 pages

APPLICATION form_Cert-Dipl_2015-16

This document is an application form for admission into certificate and diploma programs at Stella Maris Mtwara University College for the 2015/2016 academic year. It includes sections for personal particulars, emergency contact, education background, program choices, payment details, and required attachments. Applicants must submit the completed form along with a non-refundable application fee and necessary documents to the university's admission office.

Uploaded by

mkizag77
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FOR OFFICIAL USE ONLY

Affix 2 stamp size


photos with names
written at the back

STELLA MARIS MTWARA UNIVERSITY COLLEGE


(A Constituent College of St. Augustine University of Tanzania)

P. O. BOX 674, Mtwara, Tanzania

Tel: 023-2334482, Fax: 023-2334483

Email: [email protected] , Website: www.stemmuco.ac.tz

APPLICATION FORM FOR ADMISSION INTO CERTIFICATE AND DIPLOMA


PROGRAMMES FOR 2015/2016 ACADEMIC YEAR
(Note: Please fill all details in capital letters)

1.0 PERSONAL PARTICULARS


1.1 Surname:………………………………………………………………………….………………..….…..
First name:……………………………..….………… Middle Names:……………………………..…..
(Note: The names and initials entered in this form must be the same as those appearing on your
certificates to be used for admission)
1.2 Sex: Male Female
1.3 Date of Birth:………………………………………………..
1.4 Place of Birth:………………………………………………1.5 Citizenship:…………………….………
1.6 Religion:…………………………..……….1.7 Marital Status …………………………………..………
1.8 Address: ……………………………………………………………………...…………………..….…….
1.9. Telephone Number (S):……………………………………………E-mail:…………………...…………
1.10 Profession: …………………………………………………………………….……………..…….……..
1.11 Father’s Name:………………………………………………Occupation:……………………………….
1.12 Mother’s Name:………………………………………………Occupation:………………………………
1.13 Do you have any kind of disabilities: Yes No
If Yes Specify……………………………………………………………………………………….………
2.0 PERSON TO BE CONTACTED FOR EMERGENCY
2.1 Full Name: ……………………………………………………………………………………………….
2.2 Relationship: ……………………………………………………………………………...……………..
2.3 Address: ………………………………………………………………………………………………….
2.4 Telephone: ………………………………..…… E-mail ……………………………….……………..

3.0 EDUCATION BACKGROUND


Secondary School Date Started Date Completed Index Number
Attended (Month/Year) (Month/Year)

3.1 University/College Education

Have you attended this University/College or any Institutions of Higher Learning before?

Yes No

If yes, provide details in the table below.

S/N Institution Attended Status (Graduated/ If graduated give Date Obtained


Discontinued/ qualification
Absconded) attained

Total number of years of schooling: Years……………………………Months…………………………………..

4.0 PROGRAMMES OF CHOICE (Select from the list in the next page)
Order of Preference Full Name of Programme
1st Choice
2nd Choice
3rd Choice
DIPLOMA PROGRAMMES
1. Diploma in Business Administration
2. Diploma in Accountancy
3. Diploma in Procurement and Supply Chain Management.
4. Diploma in Librarianship and Records Management.
5. Diploma in Law
6. Diploma in Community Development
7. Diploma in Primary Teacher Education
Entry Requirements: At least One A’ level principal pass, OR “O’ level four passes with a Certificate from
an institution recognized by NACTE.

CERTIFICATE PROGRAMMES
1. Certificate in Librarianship and Records Management
2. Certificate in Business Administration
3. Certificate in Accountancy
4. Certificate in Procurement and Supply Chain Management
5. Certificate in Law
6. Certificate in Community Development
Entry Requirements: Any Four O’ Level Principal Passes.

5.0 PAYMENTS

Your non-refundable application fee of Tshs.20,000/= should be paid to SAUT Mtwara via Bank Account
Number: 01J1054341501 CRDB BANK, Mtwara Branch (No Cheques are accepted).

Tuition Fees to be paid to SAUT School Fees Via Account Number 0150054341502 CRDB BANK,
Mtwara Branch (No Cheques are accepted).

6.0 ATTACHMENTS
(i) Two (2) passport size photos of yourself (Colored).
(ii) Photocopies of your school certificates OR Results Slip (Form IV and Form VI).
(iii) Birth certificate.
(iv) Original pay slip of 20,000/=(for Tanzanians) OR $25 (for foreigners).

NOTE: When you have attached all required materials, kindly send this form to the address below; (Please
do not send by fax /E-mail)

Admission Office, Stella Maris Mtwara University College, P.O. BOX 674, Mtwara, Tanzania

Declaration:
I declare that all information given in this form is correct.

Signature of Applicant:……………………………………..Date:…………………………….………………….

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