LOCAL GOVERNMENT TRAINING INSTITUTE by h1w8D5

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									                    LOCAL GOVERNMENT TRAINING INSTITUTE

                               HOMBOLO, DODOMA


                                P.O. BOX 1125 Dodoma
:
                                 Tel: 0732960274                              PASSPORT
0786532146                            2960210                                   SIZE
                                      0784334084
                                      0732960274

                               E-mail – lgti@pmoralg.go.tz
                               Website: www.pmoralg.go.tz



                   APPLICATION FORM FOR ADMISSION

Application for admission to Certificate and Diploma courses tenable at the Local
Government Training Institute (LGTI): Hombolo, DODOMA

    NOTE:    (a)      Applicant must affix a passport size photograph. Application form
                      without a photograph will not be considered.

             (b)       This form when completed must reach the Principal by 15th June
                       2008. Forms received after this date will not be considered.

             (c)       Each applicant must pay a non- refundable fee of Tshs 15,000/=
                       for the form. Application forms will not be processed without
                       receipt of application fee. The payment should be made at our cash
                      office Hombolo or through the Institute’s Bank Account
                      Na.01J1081644500 CRDB-DODOMA BRANCH. Bank’s Pay-
                      In- Slip should be submitted together with this application form.




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I   APPLICANT`S PARTICULARS

    Please use capital letters. The names entered on this form must be the same as
    those appearing on relevant certificates i.e. C.S.E.E, A.C.S.E.E. or equivalent
    document.

    1.     Surname ……………………………………………………………………

    2.     First Name………………………………………………………………….

    3.     Other names……………………………………………………………….

    4.     Sex …………………………………………………………………………

    5.     Date of Birth……………………………………………………………….

    6.     Place of Birth ……………………………………………………………..

    7.     Permanent Home Address………………………………………………….
           …………………………………………………………………………….

    8.    Contact Address ……………………………………………………………
           ……………………………………………………………………………
    9.    E-mail Address …………………………………………………………..

    10.    Telephone No……………………………………………………………..

    11.   Marital Status...…………………………………………………………….

    12    Name and Address of Spouse……………………………………………...
            …………………………………………………………………… …….

    13.   Number of children………………………………………………………….

    14.   Citizenship…………………………………………………………………...

    15.   Name and address of Employer/Sponsor
                 ………………………………………………………………………
                 ………………………………………………………………………
                 ………………………………………………………………………




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II   EDUCATION BACKGROUND
(a) Certificate of Secondary Education Examination (C.S.E.E ) or Equivalent

   (From………………….to…………………Index Number………………….)

              SUBJECT                      GRADE




Examination Authority ………………………….. …………………….Division…….
Examination Centre/ School. …………………………………………………………
Country ………………………………………………………………………………


(b) Advanced Certificate of Secondary Education Examination (A.C.S.E.E.) or
    Equivalent

  (From…………………….to……………………Index Number………………)


                  SUBJECT                       GRADE




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  Examination Authority ………………………….. …………………Division………...
  Examination Centre / School. …………………………………………………………
  Country ………………………………………………………………………………


  (c) Details of Any Other Qualifications e.g. Diploma, Certificate etc.

INSTITUTE/       COURSE TAKEN         FROM       TO         INDEX
INSTITUTION                           (YEAR)     (YEAR)     NUMBER         AWARD




  (d)    Employment Record


        EMPLOYER                     POST HELD                      DATE




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16. Study Programme at LGTI

       (a) Proposed fields of study (Please tick (V) the appropriate field)

                i)    Certificate in Local Government Administration

                ii)   Certificate in Local Government Accounting and
                      Finance

                iii) Diploma in Local Government Administration


                iv) Diploma in Local Government Accounting and
                    Finance

       (b) Why do you think this field of study is relevant?

            ……………………………………………………………………………
            ……………………………………………………………………………
            ……………………………………………………………………………

        (c) Have you applied to any other Institution /Institute?
                                                                        YES

                                                                         NO

   If the answer is YES, mention the course(s) applied for and respective
   Institution/Institute ……………………………………………………………….
    ……………………………………………………………………………………


17. Do you have any Physical or Communication Disabilities?
                                                                     YES

                                                                      NO

       (a) If YES above tick whichever is applicable
           Speech / Hearing / Mobility / Vision / Others

(c) Give details of disability……………………………………………………….
       …………………………………………………………………………………
       …………………………………………………………………………………
       ……………..……………………………………………………………………




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III   GENERAL INFORMATION

      1.    Completion of the form
            Forms are to be completed in duplicate using BLOCK LETTERS.
            One copy should be returned to the Institute through the address given
            below. The second copy should be retained by the Employer/Sponsor (if
            any)

      The Principal
      Local Government Training Institute (LGTI) Hombolo
      P. O. Box 1125,
      DODOMA,
      TANZANIA.

      2.    Documents to be enclosed
                i)     Completely filled in application forms

                 ii)    Certified copies of your original certificates e.g. Certificates
                        for Secondary School Education both Form IV and Form VI.

                 iii)   A certified copy of your academic transcript

                 iv)    A certified copy of your birth certificate

                 v)     Two recent passport size photographs

                 vi)    A copy of any evidence that application fee has been paid


IV    DECLARATION BY THE CANDIDATE

      I……………………………………… hereby certify that the information in this
      Application form is correct and complete.

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




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V.            DECLARATION AND CONFIRMATION OF EMPLOYER/SPONSOR


        I/We…………………………………….hereby certify that information filled in
this application form is correct, true and complete and that I/We guarantee to sponsor the
applicant.

Name and Signature of Employer/Sponsor

…………………………………………………………………………………………….
.............................................................................................................................................


Date……………………………………




NOTE: Fees structure is attached in appendix 1




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                               APPENDIX 1

     FEES STRUCTURE FOR CERTIFICATE AND DIPLOMA COURSES FOR
                     ACADEMIC YEAR 2008/2009

A:     Direct student cost payable to the Institute (LGTI)

                                                      DIPLOMA
                              CERTIFICATE             COURSES
No.     ITEM                  COURSES ( Tshs.)        (Tshs.)
     1 Tuition fees               350,000.00           420,000.00
     2 Registration               15,000.00             15,000.00
     3 Examination fees           20,000.00             20,000.00
     4 Identity card               5,000.00             5,000.00

     5 Field supervision          50,000.00             50,000.00
     6 Accommodation              200,000.00           200,000.00

     7 Students' Union.           10,000.00             10,000.00
     8 Medical charges            50,000.00             50,000.00
        TOTAL                     700,000.00           770,000.00


B:      Other Recommended Direct Student Minimum Costs
       (Incurred by Student and/ or Sponsors)

                                                       DIPLOMA
                              CERTIFICATE              COURSES,
No.     ITEM                  COURSES, Tshs.             Tshs.

     1 Meals allowance*               784,000.00          784,000.00

     2 Books and Stationery           120,000.00          120,000.00
       Field Practical
     3 expense**                          84,000.00       168,000.00

        TOTAL                         988,000.00        1,072,000.00



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* The amount was derived at by taking the recommended rate per day (i.e. 5,000/=) and
number of days in 17 study weeks in a Semester (there are 2 semesters in one academic
year).
** The amount was derived at by taking the recommended rate per day (i.e. 6,000/=) and
number of days in Field Practice (i.e. 2 weeks for certificate Courses and 4 weeks for
Diploma courses).




Mode of payments


(i)       Registration and identity card are paid only once during first year.

(ii)      Payments can be made in two installments (i.e. semester I and Semester
          II.)

(iii)     At least 400,000/= must be paid on arrival to the Institute (Semester
          one)) for Certificate Courses and 470,000 for Diploma Courses



NOTE:

1) Fees once paid are not refundable

2) Local Government Training Institute reserves the right to change the rate of
   fees any time during the Academic year as deemed necessary without prior
   notes
3) Other recommended direct student costs (incurred by sponsors or students) are merely
   indicative




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