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Application Form

This document is an application form for programs at Mulanje Mission College of Nursing, specifically for a Diploma in Nursing & Midwifery and a Certificate in Community Midwifery. It includes sections for personal details, academic records, application fee payment instructions, and a declaration of truthfulness. Applicants must submit the completed form along with a bank deposit slip and other required documents to the specified address or via email/WhatsApp.

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skillsetmalawi
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17 views3 pages

Application Form

This document is an application form for programs at Mulanje Mission College of Nursing, specifically for a Diploma in Nursing & Midwifery and a Certificate in Community Midwifery. It includes sections for personal details, academic records, application fee payment instructions, and a declaration of truthfulness. Applicants must submit the completed form along with a bank deposit slip and other required documents to the specified address or via email/WhatsApp.

Uploaded by

skillsetmalawi
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICATION FORM

In the table below, tick the program that you are applying for

No. PROGRAM Tick


here
1 Diploma in Nursing & Midwifery (NMT)
2 Certificate in Community Midwifery

A. PERSONAL DETAILS

1. Surname: First Name: Initials:

2. Date of Birth: / / Sex: M/ F

3. Nationality:

4. Home District: T/A: Village:

5. Contact Address:

Tel: Mobile: Email:

6. Next of Kin’s Name & Address:

Tel: Mobile: Email:

7. Parent’s/Guardian’s occupation:

8. If selected, who will you pay for your fees?


B. ACADEMIC RECORD

(MSCE/IGCSE OR OTHER EQUIVALENT INTERNATIONALLY RECOGNIZED


QUALIFICATIONS AT ‘O’ LEVEL)

MSCE: O-Level: A-Level : Other: Specify

Name of Secondary School:

Year attained MSCE:

No. SUBJECT GRADE


1
2
3
4
5
6
7
8

C. APPLICATION FEE

All applicants are STRICTLY required to DEPOSIT a non-refundable application fee of


K15,000.00 to the following bank accounts:

Bank Name National Bank of Malawi


Account Name Mulanje Mission College of Nursing
Account Type Current
Account Number 582627
Branch Mulanje

Note: A copy of the deposit slip bearing the name of the applicant should be attached to
the application form. Bank deposits will be verified.
D. CANDIDATES WITH SPECIAL NEEDS

State your physical impairment and any special assistance/facilities that you require

E. DECLARATION

I hereby certify that the


information given above is true and to the best of my knowledge.

Signature: Date:

F. SUBMISSION OF AN APPLICATION FORM

A duly completed application form together with a bank deposit slip showing the name of the applicant
and copies of MSCE/Notification and a copy of the national ID attached should be sent or submitted to
the address given below or through WhatsApp or email.

Mulanje Mission College of Nursing

Office Box 45

Mulanje

Email: mjnursingcolloege@[Link]

WhatsApp: 0998 830 060/ 0888 420 850

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