2011 2012 application formKMTC/QP-01/CAF THIS FORM IS STRICTLY NOT FOR SALE Kenya Medical Training College
ISO 9001: 2008 Certified
Ref FORM FOR PRE-SERVICE CANDIDATES (KENYANS) (CERTIFICATE/DIPLOMA COURSES 2011/12 ACADEMIC YEAR) Please complete this form and send to the Director, KMTC P.O Box 30195 - 00100 Nairobi.
The form should be filled in BLOCK letters.
Attach copies of result slip/certificates, leaving certificates and ID, Passport or Birth Certificate.
Attach Application Fee in form of a Banking slip or Bankers Cheque (Kshs1000) Payable to The Director KMTC Account No.0100358521700 at National Bank Hospital Branch (KNH).Read the guiding notes overleaf carefully before filling this form SECTION A: Applicants Personal Particulars i.Name as per ID/Passport/Birth Certificate.ii.Postal AddressCode....................................................iii.Date of Birth ID/PP No..Gender Male
Female iv.Name of next of Kin ..Relationship ........v.County District.Constituency Division .SECTION B: Course Application Details: Indicate 2 Choices either in Diploma or Certificate level in order of Priority: i)Course Choices st Choice Diploma ............
Certificate.nd Choice: Diploma ..
Certificate.ii) Category (tick where II /Parallel (Preferred Campus) .
SECTION C: Applicants Education Background: (Attach copies of certificates) School Attended.Year of Exam
Kenya Medical Training College - Kmtc | Home
KENYA MEDICAL TRAINING COLLEGE TRAINING OPPORTUNITIES 2011/2012 ACADEMIC YEAR ... email@example.com . KMTC/QP-01/CAD 2 Diploma â¦ (kmtc.ac.ke)
Kenya Medical Training College Iso 9001: 2008 Certified Ref No.
Kenya Medical Training College ISO 9001: 2008 Certified Ref No._____ APPLICATION FORM FOR ... Email: firstname.lastname@example.org P.O Box 30195 00100, Nairobi Kenya (kmtc.ac.ke)
Ministry Of Health, Kenya - U.s. Agency For International Development
The Kenya Medical Training College gratefully acknowledges the technical ... Inpatient Admissions All the inpatient payment details are completely and (boruetthsm.wikispaces.com)
Do you have any disability?
Give details of
the nature of Disability: SECTION E: Applicants Declaration: I declare that the information given herein is true and accurate to the best of my knowledge and fully understand that
any information found to be false may lead to automatic disqualification ..Telephone: +254-2-2725711/2/3/4 Fax: +254-2-2722907 Website: www.kmtc.ac.keEmail: email@example.com
P.O Box 30195 00100, Nairobi Kenya Telegrams.MEDTRAIN Nairobi
(Surname) (Other names) KMTC/QP-01/CAF THIS FORM IS STRICTLY NOT FOR SALE SECTION F: Scoring (For official use only)
Applicants % Score: Rank/Position.......
Entry Done by (Name): ..
Verified by ( Not Shortlisted________ Guiding Notes 1.This form should be filled in BOLD LETTERS2.This form should be neat with no alterations whatsoever.3.Attach separate form to give full details of your disability to help us determine the best suited course for the applicant.4.Attach all relevant academic and professional certificates.5.Fill this form to the best of your knowledge.6.Make three course choices in order of priority 7.GOK sponsored is regular category with subsidized fees but very competitive.Module II costs slightly more.
8.Change of category after admission is not acceptable 9.Accommodation for both categories is optional.Item Grade Points Mean Science