STUDENTS`S ADMISSION FORM 4






Tanganyika Open School

Reg. No. IAE/OS/0338






Located at Survey Area,
AlongArdhi University/Makongo Road,
Behind ESAURP Village Building,
P. O. Box 34336,
Dar es Salaam.



  +255 657 500 500     
  +255 744 989 898
  +255 753 513 084
  +255 686 989 898


 

 


STUDENT’S ADMISSION FORM  4


S/N


1.  Full  Name_____________________________________________________

2.    ( i )  Date of Birth ____________________(ii) Sex ( Male/Female)__________

( iii )  Nationality  ____________________________ (iv)Religion: ______________________________

( v) Marital Status ( Single / Married /  etc ) ______________________

6.      Student’s Contact Address

( i )   P.O. Box        _____________________________________Tel ____________________________

( ii )   Street______________________ Area  __________________District _______________________

7.      Parent’s/Guardian’s Contact Address:  

( i )  Name    __________________________________________________     Tel.__________________

( ii )   Guardian           ____________________________________________    Tel.__________________

( iii )   P.O. Box        ____________________________________________________________________

         (i v )   Street______________________ Area  __________________District _______________________


8.      a)      Highest level of education reached.  (eg. Standard Seven/ Form  I, II, III, IV, V, etc )..............
b)      Previous Institutions (Schools &Colleges) Attended:

NAME OF
INSTITUTION /
SCHOOL
YEARS ATTENDED
(e.g. 204-2007)

COURSE NAME
(e.g. QT/CSE Course)

AWARD
(e.g. CSE/ACSE)
EXAMINING  BODY
(eg  NECTA)





















6. a) Course(s) and fee structure: Enter a tick against a course you are applying for.


S/N

PAY-MENTS MADE (ONCE A YEAR)

Annual Fee in Tsh.

TICK

 

COURSES OFFERED


Monthly
Fee

TICK

1.

Admission 

25, 000/=


1.
Stage I: Qualifying Test  - QT
( One Year Program)
T sh. 50,000/=


2.
Institute of Adult Education

50,000/=


2.
Stage II: Form III-IV Surgery  Course( One Year Program)
T sh. 50,000/=



3.

Books Project

5,000/=


3.
Form I-IV  Review Course
( One Year Program)
T sh. 50,000/=



4.
(a) Uniforms
(b) Study Tour
(c) Graduations (2)

40,000/=
35,000/=
 15,000/= x2




4.


Stage III: Form  V-VI Surgery  Course( One Year Program)
T sh. 60,000/=


5
Iinstitut
Pre-National Exams Education

25,000/=



5.

English Courses (Three Stages)
3 Months per Stage

T sh. 70,000/=


6

Identity Card

10,000/=








√ = Compulsory cost that every new student must pay before registration.

b)Enter a tick (√) against the session you wish to join.

MORNING SESSION  (8:00 a. m - 2:00 p.m )


EVENING SESSION  (4: 00 p.m - 07:00 p.m)







  7.  (a)   Mode of Payments
All payments are made before commencement of the course and the beginning of each month by the 3rddate  of the respective month of study. Payments MUST be made in the Accounts’ Office or through bank account. Receipts are issued for each payment.
  (b) Initial Payment for new students is  T sh. 110,000/=  and 50,000/= for each of the following months.

     8. Medical Information

d)      Hospital / Dispensary (In case of emergency) ……………………………………………………..

e)       Doctor’s Name  …………………………………….  (d)  Phone  ………………………………..

f)       State any serious distinguishable Medical or Behavioural Problem ( e.g. Allergy, Epilepsy,  TB, etc.)

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

10.              Student’s Declaration :

I hereby declare that the information I have supplied on this form is true and I will abide by the rules and regulations of this institution.

Student’s Signature……………………………. Date ………….…. ………………


10. FOR OFFICIAL USE ONLY


I…………………………………………………………...( Registrar’s Name).hereby declare that the above

applicant hasfulfilled all the requirements regarding student registration  and therefore the applicant is

admitted  for the…………………….....................course.His / Her Admission  number is……………..….




   Registrar’s Signature…………………………… Date ………….…………….





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