Application Form - Muhimbili University of Health and Allied Sciences

For Offial Use Only
Affix tw o
stamp size
photographs
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
APPLICATION FORM FOR ADMISSION TO ORDINARY DIPLOMA AND ADVANCED DIPLOMA PROGRAMMES FOR
THE ACADEMIC YEAR 2013/2014
Three filled copies of this form together with copies of school certificates be sent to: Director, Undergraduate
Education/Admissions Office, P.O. Box 65001, Dar es Salaam, Tanzania: due@muhas.ac.tz
(Please read carefully the Instructions to Applicants attached before filling in this application form)
CHOICE OF PROGRAMMES IN DESCENDING ORDER OF PREFERENCE
In the table below, enter the programmes you would like to study in order of preference. Details of the
programmes are given in the Instructions to Applicants.
Choice Programme
Code
Full Name of Programme
Specialization (when
applicable)
First Choice
Second Choice
Third Choice
1.0 PERSONAL PARTICULARS
1.1 Surname (Block Letters): ......................................................................................................................................
First Name: …………………………………..……… Middle Names: .....................................................
(Note: The names 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.)
1.2 Sex: Male [ ] Female [ ] 1.3 Date of Birth: ...................................................................
1.4 Place of Birth………………………… 1.5 Citizenship: ……………………………….………………….
1.6 Religion: …………………………….. 1.7 Marital Status: ..................................................................
1.8 Mailing Address: P.O. Box…………………………………………………………………………………...……..………….
1.9 Telephone Number(s): .............................................. e-mail: ....................................................................................
1.10 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 EDUCATION BACKGROUND AND EMPLOYMENT RECORD
2.1 Certificate of Secondary Education Examinations (C.S.E.E.)/National Form IV/or Equivalent.
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority ................................................................. Division: ....................................................................
Examination Centre or School: ..................................................... Country: ..................................................................
Address of the School you attended last: Tel. No:…………………………………….email address…………………….……
Postal Address……………………………………………………………………………………………………………………………...
2.2 Advanced Certificate of Secondary Education (A.C.S.E.E.)/National Form VI or equivalent.
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority ................................................................... Division: ..................................................................
Examination Centre or School: ....................................................... Country: .................................................................
Address of the School you attended last: Tel. No:…………………………………….email address…………………….……
Postal Address…………………………………………………………………………………………...
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2.3 Qualifications other than A.C.S.E.E, (Form VI) or its equivalent (e.g. University Degree, Diploma or
Certificate etc.):............................................................ College/Institute: .....................................................
Award: ................................................................................................................................................
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority ........................................ Division: ..............................................................
Examination Centre or School: ............................... Country: ................................................................
2.4 Post A-Level 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/
discontinued/Absconded)
If graduated give
qualification attained
Date Obtained
Address of the School you attended last: Tel. No:…………………………………….email address…………………….……
Postal Address……………………………………………………………………………………………………………………………...
2.5 Employment Record
Please give details of your employment record in the table below.
S/N Name of Employer Post Held Dates
Indicate the address of your last employer: Postal address……………..……………………………………………….……….
Email…………………………..…………………………………………Tel. No…………………………………...……………………..
3.0 APPLICATION FEE AND SPONSORSHIP:
3.1 Indicate the receipt number or crossed Postal/Money Order number attached to this form being a non
refundable Admission fee ……………………. (Note: Original receipts must be attached to this form).
3.2 Indicate the type of sponsorship for your studies (Please tick one):
Government of Tanzania [ ] Private [ ] Other (Specify) ………………………………….…………….
3.3 If you are not seeking sponsorship from the Government of Tanzania, give the full name, address,
relationship and a letter of commitment from each of your sponsors
Full Name Mailing Address Tel, Number(s)
Sponsor# 1
Sponsor # 2
Sponsor # 3
Declaration
I declare that all information given in this form is correct.
Signature of Applicant: ................................. Date: ……………………………..
(Note: The information given in this form will be used for admission purposes only. Non-disclosure of details or provision of false
information to any of the sections in this form if discovered shall render your registration with the Muhimbili University cancelled.)
________________________________________________________________________________________
FOR OFFICIAL USE ONLY
Application form has been received by the Admissions Officer, Muhimbili University of Health and Allied Sciences.
Name of Officer: ……………………………Signature .............................................. Date: ……………...………………
Decision by the SENATE: ………………..…………………….
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For Offial Use Only
Affix tw o
stamp size
photographs
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
APPLICATION FORM FOR ADMISSION TO ORDINARY DIPLOMA IN PHARMACEUTICAL SCIENCES EXECUTIVE TRACK
FOR THE ACADEMIC YEAR 2013/2014
Three filled copies of this form together with copies of school certificates be sent to: Admissions Officer, P.O. Box
65001, Dar es Salaam, Tanzania: due@muhas.ac.tz
(Please read carefully the Instructions to Applicants attached before filling in this application form)
CHOICE OF PROGRAMMES
In the table below, enter the full name of programme you would like to study under the executive track i.e
Diploma in Pharmaceutical Sciences.
Full name of Programme Programme Code Mode of conduct
DPS
Evening Classes
1.0 PERSONAL PARTICULARS
1.1 Surname (Block Letters): ....................................................................
First Name: ……………………………… Middle Names: .....................................................
(Note: The names 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.)
1.2 Sex: Male [ ] Female [ ] 1.3 Date of Birth: ...................................................................
1.4 Place of Birth………………………… 1.5 Citizenship: ………………………………..…….….……….
1.6 Religion: …………………………….. 1.7 Marital Status: .................................................................
1.8 Mailing Address: P.O. Box………………………………………………………………………………….………………….
1.9 Telephone Number(s): .............................................. e-mail: ....................................................................................
1.10 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 EDUCATION BACKGROUND AND EMPLOYMENT RECORD
2.1 Certificate of Secondary Education Examinations (C.S.E.E.)/National Form IV/or Equivalent.
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority ..................................... Division: ..................................................................................
Examination Centre or School: .................................... Country: .....................................................................
Address of the School you attended last: Tel. No:………………………….email address…………………….……
Postal Address……………………………………………………………………………………...……………………………
2.2 Advanced Certificate of Secondary Education (A.C.S.E.E.)/National Form VI or equivalent.
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority .......................................... Division: .............................................................................
Examination Centre or School: ................................. Country: ........................................................................
Address of the School you attended last: Tel. No:………………………………email address…………..…………
Postal Address…………………………………………………………………………………………………………………...
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2.3 Qualifications other than A.C.S.E.E, (Form VI) or its equivalent (e.g. University Degree, Diploma or
Certificate etc.):............................................................ College/Institute: .....................................................
Award: ..........................................................................................................................................................................
Subject Grade Year Index No Subject Grade Year Index No
Examination Authority ........................................ Division: ...............................................................................
Examination Centre or School: ............................... Country: ..........................................................................
Address of the School you attended last: Tel. No:…………………………email address……………………..……
Postal Address…………………………………………………………………………………………………………………...
2.4 Post A-Level 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/
discontinued/Absconded)
If graduated give
qualification attained
Date Obtained
2.5 Employment Record
Please give details of your employment record in the table below.
S/N Name of Employer Post Held Dates
Indicate the address of your last employer: Postal address……………..……………………………………………….……….
Email…………………………..…………………………………………Tel. No…………………………………...……………………..
3.0 APPLICATION FEE AND SPONSORSHIP:
3.1 Indicate the receipt number or crossed Postal/Money Order number attached to this form being a non
refundable Admission fee ……………………. (Note: Original receipts must be attached to this form).
3.2 Indicate the type of sponsorship for your studies (Please tick one):
Government of Tanzania [ ] Private [ ] Other (Specify) ……………………….…………….
3.3 If you are not seeking sponsorship from the Government of Tanzania, give the full name, address,
relationship and a letter of commitment from each of your sponsors
Sponsor# 1
Full Name Mailing Address Tel, Number(s)
Sponsor # 2
Sponsor # 3
Declaration
I declare that all information given in this form is correct.
Signature of Applicant: ................................. Date: ……………………………..
(Note: The information given in this form will be used for admission purposes only. Non-disclosure of details or provision of false
information to any of the sections in this form if discovered shall render your registration with the Muhimbili University cancelled.)
________________________________________________________________________________________
FOR OFFICIAL USE ONLY
Application form has been received by the Admissions Officer, Muhimbili University of Health and Allied Sciences.
Name of Officer: ……………………………Signature ............................................... Date: …………………….………
Decision by the SENATE: ………………………………….
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MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
Admissions Office, P.O. Box 65001, Dar es Salaam, Tanzania
Instructions to applicants seeking admission to Ordinary Diploma in Pharmaceutical
Sciences Executive Track
Applicants are required to read these instructions carefully before filling in the
application forms. Incorrectly filled or incomplete application forms will not be
processed.
1.0 APPLICATION FEES
Submission of duly filled application forms should be accompanied with payment of
non-refundable Application fee. The application fee for Tanzanians is TShs. 20,000/=
and for non-Tanzanians is USD 30. All payments should be deposited into the
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES, NATIONAL MICROFINANCE
BANK OF TANZANIA LIMITED (NMB) ACCOUNT NUMBER 2091100002 (MUHIMBILI
BRANCH). Remember to use the applicant’s name and make sure that you attach to
your application forms a copy of our receipt which you will obtain at our Bursar’s
office after presentation to him the original pay-in slip of the application fee.
Applicants are advised to keep a copy of the receipt and pay-in slip for future use
whenever required.
2.0 ORDINARY DIPLOMA PROGRAMMES
The programme offered by MUHAS under executive track is Ordinary Diploma in
Pharmaceutical Sciences conducted during the evening.
3.0 SUBMISSION OF APPLICATION FORMS
Duly filled application forms should be handed in to the Admissions Office, Muhimbili
University. Application forms may also be posted to:
Director, Undergraduate Education,
Admissions Officer,
P.O. Box 65001,
Dar es Salaam, Tanzania.
The deadline for submission of duly filled application forms is 4 p.m. on Friday
31 st May, 2013. Application forms received thereafter (whether submitted in person or
otherwise) shall not be processed.
4.0 WARNING
It should be noted that it is an offence to submit false information when applying for
admission. Applicants who will be discovered to have submitted forged certificates or
any other such information will not be considered and appropriate legal action will be
taken against them. Bonafide University students are cautioned not to attempt
applying for admission. If such students submit their applications then they will be
liable to de-registration from studies. Likewise, former students who have already
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graduated cannot be admitted as undergraduate students under Government loan
sponsorship.
5.0 FINAL CHECKLIST OF APPLICATION FOR ADMISSION
Since incomplete application forms will not be processed, it is important that the
applicant checks whether three sets of application forms are made and all the items
indicated below are included in her/his application submission.
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Four stamp size black and white photographs with applicant’s name written at
the back
Three copies of certificates and/or result slips for O-Level or equivalent
Three copies of certificates and/or result slips for A-Level or equivalent
Three copies of Birth Certificate and/or Affidavit
The original bank pay-in slip for the payment of the non-refundable Application
fees.
A letter of commitment from your sponsors indicating his/her commitment on
paying the required fees and other related payment to the University
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MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES (MUHAS)
INVITATION FOR ADMISSION INTO DIPLOMA AND ADVANCED DIPLOMA PROGRAMMES
FOR THE ACADEMIC YEAR 2013/2014
Applications are invited from qualified candidates who completed form four or form
six or candidates with equivalent qualifications wishing to pursue the following
Diploma or Advanced Diploma programmes at the Muhimbili University of Health
and Allied Sciences for the academic year 2013/2014
1.0 DIPLOMA IN MEDICAL LABORATORY SCIENCES (3 YEARS)
i) Direct Entry
Credits in Biology and Chemistry and one in either Physics or
Mathematics at ‘O’ level.
ii)
Equivalent Qualifications
Laboratory Assistant with three years experience who has passed the
selection examination recognized by the University and must have ‘O’
level secondary school certificate.
2.0 DIPLOMA IN ENVIRONMENTAL HEALTH SCIENCES (3 YEARS)
i) Direct Entry
Pass in English and three credit passes, one in Mathematics and two
other out of Physics, Chemistry and Biology at ‘O’ level.
ii)
Equivalent Qualifications
Health Assistant with three years experience who has passed the
selection examination recognized by the University and must have ‘O’
level secondary school certificate.
3.0 DIPLOMA IN DIAGNOSTIC RADIOGRAPHY (3 YEARS)
i) Direct Entry
C grade or higher passes in three out of Physics, Chemistry, Biology and
Mathematics and at least D grade pass in English. Physics is a major
subject.
ii)
Equivalent Qualifications
Radiographer Assistant with three years experience who has passed the
selection examination recognized by the University and must have ‘O’ -
level secondary school certificate.
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4.0 DIPLOMA IN ORTHOPAEDIC TECHNOLOGY (3 YEARS)
i) Direct Entry
Three credit passes out of Physics, Chemistry, Biology or Mathematics at
O’level. Credit pass in engineering subjects is also acceptable as the
third credit pass.
ii)
Equivalent Qualifications
Candidates must have certificate in lower limb Prosthetics or Orthotics
and must have two credit passes in science subjects at “O” level.
5.0 DIPLOMA IN PHARMACEUTICAL SCIENCES (3 YEARS)
i) Direct Entry
Three credit passes which must include Maths, Chemistry and English
with a pass in Biology and Physics.
ii)
Equivalent Qualifications
Pharmaceutical Assistant with three years experience who has passed
the selection examination recognized by the University and must have
‘O’ level secondary school certificate.
6.0 DIPLOMA IN NURSING (3 YEARS)
Entry Requirements
i. Candidates must have completed O-level education with a credit in
Biology and two passes in Chemistry and Mathematics or Physics.
ii.
Candidates must have completed secondary school education within
three years from the year of application.
7.0 ADVANCED DIPLOMA IN DERMOTOVENEREOLOGY (2 YEARS)
i) Direct Entry: Not Applicable
ii)
Equivalent Qualification
Have successfully completed any one of the following courses with an
overall good performance grade(s); Assistant Medical Officer (AMO) in
Tanzania and In Other countries: Medical Assistant, Clinical Officer, Nurse
Clinician and Family Nurse Practitioner
Or an equivalent level, AND must possess ‘O’ level secondary school
certificate with passes in Physics, Chemistry and Biology.
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8.0 ADVANCED DIPLOMA IN MEDICAL LABORATORY SCIENCES 2 YEARS
i) Direct Entry: Not Applicable
ii)
Equivalent Qualifications
Medical Laboratory technicians who hold a good Diploma in Medical
Laboratory Sciences or its equivalent with two years working experience.
Must possess ‘O’ level Secondary School Certificate with passes in
Physics, Chemistry and Biology.
9.0 ADVANCED DIPLOMA IN NURSING EDUCATION 2 YEARS
i) Direct Entry: Not Applicable
ii)
Equivalent Qualifications
Registered Nurse with two years experience, who has passed the
matriculation examination and must be a holder of ‘O’ level Certificate
with credit/pass in Chemistry, Biology and English.
Applicants should obtain application forms from the Admissions Office,
Multipurpose Laboratory Building, First floor, Room No. 25, MUHAS Website:
www.muhas.ac.tz, Muhimbili University of Health and Allied Sciences or
through the following address:
Director, Undergraduate Education,
Muhimbili University of Health and Allied Sciences,
P.O. Box 65001,
Dar es Salaam, Tanzania.
Deadline for submission of duly filled in application forms is strictly at 4:00pm on
Friday, 31 st May, 2013.
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MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
(MUHAS)
INVITATION FOR ADMISSION INTO DIPLOMA IN PHARMACEUTICAL
SCIENCES, EXECUTIVE TRACK FOR THE ACADEMIC YEAR 2013/2014
Applications are invited from qualified candidates who completed either form four
or form six or candidates with equivalent qualifications wishing to pursue studies in
Diploma in Pharmaceutical Sciences at the Muhimbili University of Health and Allied
Sciences for the academic year 2013/2014. This is an evening class programme.
(a)
(b)
(c)
PROGRAMME
Diploma in Pharmaceutical Sciences, executive track
DURATION
Three (3) years
ENTRANCE QUALIFICATIONS
i) Direct Entry
Three credit passes which must include Maths, Chemistry and English
with a pass in Biology and Physics.
ii)
Equivalent Qualifications
Pharmaceutical Assistant with three years experience who has passed
the selection examination recognized by the University and must have
‘O’ level secondary school certificate.
Applicants are advised to obtain Application Forms and the Instructions to
Applicants document from the Admissions Office, Multipurpose Laboratory Building,
First Floor, Office No. 25, Muhimbili University of Health and Allied Sciences, or through
the following address:
Director, Undergraduate Education,
Muhimbili University of Health and Allied Sciences,
P.O. Box 65001,
Dar es Salaam, Tanzania.
Tel: (022-2150473)
E-Mail: due@muhas.ac.tz
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Application forms and Instructions to applicants can also be downloaded from the
Muhimbili Website: www.muhas.ac.tz,
Applicants must:
(i) Carefully read the accompanying ‘Instructions to Applicants’ before
attempting to fill the application forms.
(ii)
(iii)
(iv)
Give full particulars of citizenship (including a copy of the birth certificate) and
enclosing photocopies of their academic certificates. Applicants with
academic certificates other than those issued by the National Examinations
Council of Tanzania (NECTA) must submit a translation by the NECTA indicating
equivalent grades to Tanzanian ones. This is in addition to submission of the
original grades.
Pay a non-refundable application fee of T. Shs. 20,000/= for Tanzanians and
USD 30 for non-Tanzanians into the Muhimbili University of Health and Allied
Sciences National Microfinance Bank of Tanzania Limited (NMB) account
number 2091100002 (Muhimbili branch) and submit the original pay-in slip
together with the application forms.
Ascertain themselves that they possess the minimum entrance qualifications
before they pay the fees as the fees will not be refunded under any
circumstances.
Deadline for receiving application forms is strictly at 4 p.m. on Friday, 31 st May 2013
NB:
*WARNING*
It should be noted that it is an offence to submit false information for admission.
Any candidate who will be discovered to have submitted a forged certificate
or any other such information will not be considered and appropriate legal
action will be taken against them.
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MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES (MUHAS)
ADMISSION INTO UNDERGRADUATE DEGREE PROGRAMMES FOR THE ACADEMIC YEAR
2013/2014
Direct and Indirect/Equivalent applicants
Applicants who fall under the Direct and Indirect/Equivalent categories as recently
defined by Tanzania Commission for Universities (TCU) should apply for the degree
courses through the Central Admission System. More information on how to apply is
available at TCU office and Website.
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