Francis School of Nursing and Midwifery

Application for Enrolled Nursing Diploma

PERSONAL DETAILS (Please complete using block capital letters throughout)
Surname (Family ame):
Other Names :
Date of birth:
Gender:
Address:
 
Telephone:
e-mail:
Country of birth
Nationality

EDUCATION AND/OR PROFESSIONAL QUALIFICATION
(In date order i.e. most recent first, Indicate School):

  School Qualification Subject Grade
1 
2 
3 

OTHER COURSES AND EXPERIENCE (Details of any other courses taken or qualifications):

  Date of Course Title of Course Qualification
 

ADDITIONAL PERSONAL DETAILS (Name and address of emergency contact)
Name:
Address:
 

FINANCE:

Who will be paying your fees and providing funds for living expenses?
If you have arranged sponsorship, give the name and address of your sponsor below and enclose a copy of your letter of confirmation of funding.
Name:
Address:
 
Application Fees: 10.000 FCFA
Application Deadline: 1st of September
Any Criminal Conviction

DOCUMENTS TO BE COMPILED
  • Birth Certificate
  • Ordinary Level Certificate (or slip)
  • Advance Level Certificate (or slip)
  • Passport size photograph
  • Sponsorship confirmation letter for those to be sponsored

DISCLAIMER
  • I agree that the school may alter part(s) of a programme without notice.
  •  I agree that the school may suspend any programme or my place on that programme.
  • I agree that the school may vary or cancel any decision it makes.
Entrance Examination: 10th September 2009

By submitting this application, I agree that if the information given on this form is later found to be false, the school may withdraw my offer or subsequent place on the programme of study. I understand that the school will use this information for the purposes of admissions and to form part of a subsequent student record if I am accepted. I give my consent to the processing of my data and to use it for statistical information and reporting that will not identify me. I confirm that the information given on this form is true, complete and accurate.