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.
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+255 657 500 500 +255 744 989 898 +255 753 513 084 +255 686 989 898 |
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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)
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AWARD
(e.g.
CSE/ACSE)
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EXAMINING BODY
(eg NECTA)
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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
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COURSES OFFERED |
Monthly
Fee
|
TICK
|
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1.
|
Admission
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25,
000/=
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√
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1.
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Stage
I: Qualifying Test - QT
( One Year Program)
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T sh. 50,000/=
|
|
2.
|
Institute of Adult Education
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50,000/=
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√
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2.
|
Stage
II: Form III-IV Surgery Course( One Year Program)
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T sh. 50,000/=
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3.
|
Books Project
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5,000/=
|
√
|
3.
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Form I-IV
Review Course
( One Year Program)
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T sh. 50,000/=
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4.
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(a) Uniforms
(b) Study Tour
(c) Graduations (2)
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40,000/=
35,000/=
15,000/= x2
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4.
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Stage
III: Form
V-VI Surgery Course( One Year
Program)
|
T sh. 60,000/=
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||
5
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Iinstitut
Pre-National Exams Education
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25,000/=
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√
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5.
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English Courses (Three Stages)
3 Months per Stage
|
T sh. 70,000/=
|
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6
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Identity Card
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10,000/=
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√
= 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 )
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EVENING
SESSION (4: 00 p.m - 07:00 p.m)
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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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