Apply for Admission

Full Name: *

Write your Full Name.

Gender: * — Male Female

Select your Gender.

Date of Birth: *

Select your Official Date of Birth.

Nationality: *

Please write Your Nationality.

National ID/Passport No: *

Marital Status: * — Single Married

Select your Marital Status.

Religion (Optional):

Write your Religion (optional).

Mobile Number: *

Enter your mobile number with country code (e.g., +211...).

Alternative Contact: *

Enter an alternative mobile number with country code (e.g., +211...).

Email Address: *

Enter your Email Address.

Residential Address: *

Enter your current Address.

Emergency Contact Person Name: *

Enter the full name of your emergency contact person.

Emergency Contact Phone Number: *

Enter the emergency contact’s mobile number with country code (e.g., +211...).

Relationship with Contact Person: *

Please describe relation with the Emergency Person (e.g. Father, Mother, Brother).

ID/Passport Photo: *

Upload clear picture of your ID card or Passport. (allowed only, jpg, png, pdf).)

Select Program: * — Diploma in Clinical Medicine and Public Health Diploma in Nursing Diploma in Midwifery Diploma in Pharmacy Medical Laboratory Sciences Nutrition & Dietetics and Public Health

Select the program you are applying for:

Preferred Mode of Study: * — Full Time Part Time (weekend/evening)

Choose your Mode of Study

Do you have any medical condition requiring attention? * Yes No

If yes, specify

If you selected Yes for the above question, please specify

Do you have any physical disability? * Yes No

If yes, specify support required

If you selected Yes for the above question, please specify what support required

National ID/Passport *

Please upload clear picture of your National ID or Passport, both Front and Back sides ( MAX 15mb. allowed only: jpg, png, pdf).

Academic Certificates and Transcripts *

Please upload clear picture of required Academic Certificates and Transcripts ( allowed only: jpg, png, pdf).

Passport Size Photograph *

Please upload Digital copy of your Passport Size Photograph ( MAX 15mb. allowed only: jpg, png, pdf).

Application Fee Payment Receipt (100,000 SSP ONLY) *

Please upload clear picture of Application Fee Payment Receipt ( MAX 15mb. allowed only: jpg, png, pdf).

Other Supporting Documents

Please upload Other Supporting Documents (If any) ( MAX 15mb. allowed only: jpg, png, pdf).

I hereby declare that the information provided in this application form is true and correct to the best of my knowledge. I understand that providing false information may lead to cancellation of my admission. * Yes, I Agree.