Application Forms for Equivalent Entry Qualification 2013_2014 ...

2.3 Qualifications other than A.C.S.E.E, (Form VI) or its equivalent (e.g. University Degree, Diploma orCertificate etc.):............................................................ College/Institute: .....................................................Award: ................................................................................................................................................Subject Grade Year Index No Subject Grade Year Index NoExamination Authority ........................................ Division: ....................................................................Examination Centre or School: ............................... Country: ..................................................................2-4 Post A-Level EducationHave you attended this University/College or any other Institutions of Higher Learning before?Yes: [ ] No: [ ]If yes, provide details in the table below.S/NInstitution AttendedStatus (Graduated/discontinued/Absconded)If graduated givequalification attainedDate Obtained2.5 Employment RecordPlease give details of your employment record in the table below.S/N Name of Employer Post Held DatesIndicate 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 nonrefundable 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 sponsorsSponsor# 1Full Name Mailing Address Tel, Number(s)Sponsor # 2Sponsor # 3DeclarationI 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 falseinformation to any of the sections in this form if discovered shall render your registration with the Muhimbili University cancelled.)________________________________________________________________________________________FOR OFFICIAL USE ONLYApplication form has been received by the Admissions Officer, Muhimbili University of Health and Allied Sciences.Name of Officer: ……………………………Signature .................................. Date: …………………Decision by the SENATE: ………………………………….2