Public Health Adimission Application Form

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Public Health Adimission Application Form Powered By Docstoc
					FOR OFFICIAL USE ONLY 




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              ST. AUGUSTINE UNIVERSITY OF TANZANIA                                                                 Stamp
                      P.O Box 307 Mwanza, Tanzania Tel: 255-028-2550560, 2550090                                   photo size with
                      Fax: 255-028-2550167, 2500575     E-mail: sautmalimbe@yahoo.com                              name clearly
                                              Website: www.saut.ac.tz                                              written at the
                                                                                                                   back


                                APPLICATION FORM FOR ADMISSION
                                         ACADEMIC YEAR 2010/2011
      ( Note: Please fill all details in block letters)
      1.0 PERSONAL PARTICULARS
           1.1 Surname: …………………………………………………………………..…………
             First Name: ………………………………… Middle Names: ………………….……………………
      (Note: The names and initial entered in this form must be exactly the same as those appearing on your A.C.S.E.E.-
      Form VI or other certificates to be used for admission. If there is no surname or middle in your certificate please do
      not write )



      1.2 Sex: Male:             Female:
      1.3 Date of Birth (Attach a copy of birth certificate): ……………...….……..…...………………………….
      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 disability? Yes:                No:         If yes, specify……………………………

            …………………………………………………………………………………………………………………………..
      (Note: This Information is required in order for the University to arrange appropriate means of assisting you once
      admitted. It will in no way affect the decision to admit you)


      2.0 FOR EMERGENCIES: Person to be contacted
      2.1 Full Name: ………………………………....…………………………………………………………….
      2.2 Relationship: ………………………………....………………………………………………………….
      2.3 Address ………………………………....……………………………………………………………….
      2.4 Telephone ………………………………….Fax: ……………………..E-mail ……………………….




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3.0 EDUCATION BACKGROUND AND EMPLOYMENT RECORD
ALL.SEC.SCHOOLS                     LOCATION         DATES FROM            TO (MO/YR)         CERT.INDEX
ATTENDED                                               (MO/YR)                                   NO




3.1 University/Collage Education
Have you attended this University/College or any other 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/Absconded)   qualification attained




Total number of years of schooling ……………….years ……….months………………………..
3.2 Employment Record

Please give details of your employment record in the table below.
S/N    Name of Employer                               Post Held                              Dates




4.0 Programme Sought in Order of Preference(Select from the list attached)
Order of           Faculty                        Programme Code            Full Name of Programme
Preference

1st Choice
2nd Choice
3rd Choice


5.0 Language fluency:
Language                                Spoken                                     Written
                             Fair       Good         Very good      Fair          Good               Very good




6.0 Referees
 Names and addresses of two referees who know your ability as a student and can assess
your competence in written and spoken English


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     (a) Full Name: ….………………..……....………………………………………..……………….……….
          Address:….………………..……....………………………………………..……………….…………..

     (b) Full Name: ….………………..……....………………………………………..……………….……….

     Address:….………………..……....………………………………………..……………….……………

7.0 Sponsorship
 The sponsor should indicate here that the candidate would receive financial support for years he or
    she will spend at St.Augustine University.

Name of sponsor: …....………………………………………..……………….………………………………
Address: ….………………..……....………………………Tel ……………………………………..
Business OR Activity ….………………..……....……………Fax/ E-mail…………………………..
I …………………………………………………..confirm that my Organization will give full financial
support to…………………………………………………………………During the period of his/her
education at St.Augustine University if he/she is accepted.
                Date ……………………………….signed………………………………………….
                               Official stamp or seal
Declaration
I declare that all information given in this form is correct.
Signature of Applicant: …………………....………. Date.………………………………………….………


8.0 PAYMENTS.

Your non-refundable application fee of Tshs 20,000/= or US $ 25 should be paid to St. Augustine University of
Tanzania via Bank Account number: 015101001461 NBC Ltd. Mwanza Branch (No Cheques are accepted)

9.0 ATTACHEMENTS.

Please include the following with this application:
(a) A medical Doctor’s Certificate stating that you are fit to follow this course.
(b) Two (2) passport size photos of yourself (Colored)
(c) A short history of your life in English (500-750 words or two fullscap) in your own handwriting, describing the
important details of your life, your reasons for pursuing this courses of studies, and your plans for the future.
(d) Photocopies of your school certificates OR results slip
(e) Birth certificate
(f) Original pay slip of Tshs 20,000/= or $ 25
When you have attached all required materials and have included certification of sponsorship (below) kindly send
this to the office of the:

Admissions Office, St. Augustine University of Tanzania, P.O Box 307 Mwanza, Tanzania.
            ST. AUGUSTINE UNIVERSITY OF TANZANIA
                                  P.O Box 307 Mwanza, Tanzania Tel: 255-028-2550560, 2550090
                      Fax: 255‐028‐2550167, 2500575       E‐mail: sautmalimbe@yahoo.com 
                                                     Website: www.saut.ac.tz       


                                      PROGRAMMES OFFERED
                                    ACADEMIC YEAR 2010/2011                                                                 
FACULTY OF BUSINESS ADMINISTRATION
Programme                  Programme Name                                                       Duration
Code
BBA                        Bachelor of Business Administration                                  3 Years
BSCP                       Bachelor of Science in Procurement and Supply chain                  3 Years
                           Management
ADA                        Advanced Diploma in Accountancy                                      3 Years
ADPLM                      Advanced Diploma in Procurement and Logistics                        3 Years
                           Management
BScT                       Bachelor of Science in Tourism                                       3 Years
CA                         Certificate in Accountancy                                           1 Year
CHA                        Certificate in Health Administration                                 1 Year
CGMFS                      Certificate in Grain Management and Food Security                    1 Year
CLM                        Certificate in Logistics and Supply Management                       1 Year


FACULTY OF SOCIAL SCIENCES AND COMMUNICATIONS
Programme                  Programme Name                                                       Duration
Code
BAMC                       Bachelor of Arts in Mass Communication                               3 Years
BAPRM                      Bachelor of Arts in Public Relation and Marketing                    3 Years
BASO                       Bachelor of Arts in Sociology                                        3 Years
BAEC                       Bachelor of Arts in Economics                                         3 Years
B Phil                     Bachelor of Arts in Philosophy                                       3 Years
BARS                       Bachelor of Arts in Religious Studies                                3 Years
CJM                        Certificate in Journalism and Media studies                          1 Year




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FACULTY OF ENGINEERING
Programme            Programme Name                                                  Duration
Code
BScEE                Bachelor of Science in Electrical Engineering                   4 Years
BScCE                Bachelor of Science in Civil Engineering                        4 Years
ITT                  IT Technician Certificate                                       1 Year


FACULTY OF LAW
Programme            Programme Name                                                 Duration
Code
LLB                  Bachelor of Laws                                               4 Years


FACULTY OF EDUCATION
Programme            Programme Name                                                 Duration
Code
BAED                 Bachelor of Arts with Education                                3 Years
B Phil Ed            Bachelor of Philosophy with Education                          3 Years


Note:
      1. In Bachelor of Arts with Education we offer major in: (History, Geography,
         Kiswahili, English Language, Literature, Economics, Mathematics and
         Commerce)
      2. Bachelor of Arts with Education and Bachelor of Arts in Sociology you will be
         selected by the University to one of the following Centres.
         a) MAIN CAMPUS (Mwanza)
         b) MTWARA
         c) TABORA

				
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Description: Public Health Adimission Application Form document sample