APPLICATION FORM FOR ACADEMIC YEAR 2022/2023

Start registration by filling the below online form. Please make sure to attach all required document as indicated

Pay 30,000/= non– refundable application fee to the following Bank Accounts:

 Account Name: KAHAMA COLLEGE OF HEALTH SCIENCES

BANK: NATIONAL MICROFINANCE BANK (NMB) ACCOUNT NUMBER: 30610017310

NB: Please, do not make payments via any other method apart from the Bank Accounts shown in this Form.

For any inquiries please, don’t hesitate to contact us via:
+255766640531; +255683170921

Apply Online

*FIRST NAME

*MIDDLE NAME

*LAST NAME

*NATIONALITY

*SEX

MALE FEMALE

*DATE OF BIRTH

DISABILITY / ULEMAVU

*REGION

Arusha Dar es Salaam Dodoma Geita Iringa Kagera Katavi Kigoma Kilimanjaro Lindi Manyara Mara Mbeya Morogoro Mtwara Mwanza Njombe Pemba North Pemba South Pwani Rukwa Ruvuma Shinyanga Simiyu Singida Tabora Tanga Zanzibar North Zanzibar South and Central Zanzibar West

*DISTRICT OF DOMICILE

Arumeru Arusha Babati Bagamoyo Bariadi Biharamulo Bukoba Rural Bukoba Urban Bukombe Bunda Chake Chunya Dodoma Rural Dodoma Urban Geita Hai Hanang Handeni Igunga Ilala Ileje Ilemela Iramba Iringa Rural Iringa Urban Kahama Karagwe Karatu Kaskazini Kasulu Kati Kibaha Kibondo Kigoma Rural Kigoma Urban Kilindi Kilolo Kilombero Kilosa Kilwa Kinondoni Kisarawe Kishapu Kiteto Kondoa Kongwa Korogwe Kusini Kwimba Kyela Lindi Rural Lindi Urban Liwale Ludewa Lushoto Mafia Magharibi Magu Makete Manyoni Masasi Maswa Mbarali Mbeya Rural Mbeya Urban Mbinga Mbozi Mbulu Meatu Micheweni Misungwi Mjini Mkoani Mkuranga Monduli Morogoro Rural Morogoro Urban Moshi Rural Moshi Urban Mpanda Mpwapwa Mtwara Rural Mtwara Urban Mufindi Muheza Muleba Musoma Rural Musoma Urban Mvomero Mwanga Nachingwea Namtumbo Newala Ngara Ngorongoro Njombe Nkasi Nyamagana Nzega Pangani Rombo Ruangwa Rufiji Rungwe Same Sengerema Serengeti Shinyanga Rural Shinyanga Urban Sikonge Simanjiro Singida Rural Singida Urban Songea Rural Songea Urban Sumbawanga Rural Sumbawanga Urban Tabora Urban Tandahimba Tanga Tarime Temeke Tunduru Ukerewe Ulanga Urambo Uyui Wete

MOBILE PHONE NUMBER

*PRIMARY SCHOOL

EMAIL ADDRESS

*SECONDARY SCHOOL

*FORM FOUR INDEX NUMBER

*YEAR OF COMPLETING FORM FOUR

NTA 5 COLLEGE NAME (FOR UPGRADING STUDENTS)

YEAR OF COMPLETION (FOR UPGRADING STUDENTS)

FINAL YEAR EXAM NUMBER (FOR UPGRADING STUDENTS)

*FULL NAME OF PARENT

PARENT PHONE NUMBER

*RELATION WITH PARENT/GUARDIAN

Father Mother Aunt Uncle Brother Sister Uhisiano na mzazi/mlezi wako

POSTAL ADDRESS

PHYSICS SCORE

A B C D F

CHEMISTRY SCORE

A B C D F

*BIOLOGY SCORE

A B C D F

*MATHEMATICS SCORE

A B C D F

*ENGLISH SCORE

A B C D F Daraja ulilopata kwenye Kiingereza

*KISWAHILI SCORE

A B C D F

*GEOGRAPHY SCORE

A B C D F

HISTORY SCORE

A B C D F

*FIRST CHOICE

TECHNICIAN CERTIFICATE IN PHARMACEUTICAL SCIENCES ORDINARY DIPLOM IN PHARMACEUTICAL SCIENCES TECHNICIAN CERTIFICATE IN CLINICAL MEDICINE (C/A) ORDINARY DIPLOMA IN CLINICAL MEDICINE (C/O)

*SECOND CHOICE

TECHNICIAN CERTIFICATE IN PHARMACEUTICAL SCIENCES ORDINARY DIPLOM IN PHARMACEUTICAL SCIENCES TECHNICIAN CERTIFICATE IN CLINICAL MEDICINE (C/A) ORDINARY DIPLOMA IN CLINICAL MEDICINE (C/O) Chaguo la pili

*FORM FOUR CERTIFICATE

LEVEL 5 CERT & TRANSCRIPT

*BANK PAYMENT SLIP

Fields with (*) are compulsory.