NURSING & MIDWIFERY COUNCIL OF ZAMBIA

LUMEZI ST JOSEPH COLLEGE OF NURSING AND MIDWIFERY

APPLICATION FORM
TRAINING PROGRAM: - REGISTERED NURSING – JAN 2026 INTAKE

SECTION I: - INSTRUCTIONS TO APPLICANT: Code No___________________

1. Give as detailed information as possible

2. Complete this form using BLOCK LETTERS and K250 deposited in college account: -
ZANACO
ACCOUNT # 5949850300185
NAME OF ACCOUNT: ST JOSEPH REGISTERED NURSING SCHOOL
BRANCH: LUNDAZI

Please Note: - The electronic bank deposit slip should also indicate name of the applicant and
presented to the registration desk.

SECTION II: PARTICULARS OF APPLICANTS:

3. Surname: -................................. Middle Name: -............................... Other Names: -...........................
4. Age: - ..........Yrs Date of Birth: - ........./........./............ 5. NRC/Passport No: -.................................
Minimum age limit is 16 years and above
6. Cell No: -..................................... Telephone: -................................. Fax No: - ……………………………………
E-mail: - ……………………………………………………………………..…………………………………………………………………….
7. Address to which the letter of acceptance can be sent: -.......................................................................
................................................................................................................................................................
8. Marital Status: - Single/Separated/Divorced/Widowed/: (If married, enclose spouse’s letter of
consent). Number of children (If any): -............. Dates of birth for Children (Start with the youngest)
a) .....................................
b) .....................................
c) .....................................
SECTION III: EDUCATIONAL PROFILE:
9. Name and address of secondary School attended: -..............................................................................
................................................................................................................................................................
10. Certificate obtained: - O’Levels/GCE Year obtained: -................... Division: -.............................
11. Subject passed and grades on Grade 12 Certificate
(Note: - Subjects in bold are compulsory and only the subjects listed below are considered and
they must be in credit or better).

a) English Language Grade: -........................... Standard: -.................................

b) Mathematics Grade: -........................... Standard: -.................................
c) Any Science subject (Indicate ________________) Grade: -.......... Standard: -.........
d) Biology Grade: -........................... Standard: -.....................................
e) Physics Grade: -........................... Standard: -.....................................
f) Chemistry Grade: -........................... Standard: -.....................................
g) Science Grade: -........................... Standard: -.....................................
h) Agriculture Science Grade: -........................... Standard: -.....................................
i) Geography Grade: -........................... Standard: -.....................................
 j) History Grade: -........................... Standard: -...............................
k) Religious Education Grade: -........................... Standard: -...............................
l) Commerce Grade: -........................... Standard: -...............................
m) Food & Nutrition Grade: -........................... Standard: -...............................
n) Home Management Grade: -........................... Standard: -...............................
o) Computer studies Grade: -........................... Standard: -...............................
p) Civic Education Grade: -........................... Standard: -...............................
q) Principles of Account Grade: -........................... Standard: -...............................
r) Art Grade: -........................... Standard: -...............................
s) Others _____________ Grade: -........................... Standard: -...............................
t) ___________________ Grade: -........................... Standard: -...............................
u) ___________________ Grade: -........................... Standard: -...............................

No payment should be deposited if you do not meet the above qualifications as no refunds SHALL BE
MADE. Ensure the compulsory subjects and any other two total up to five (5)
SECTION IV: EMPLOYMENT:
12. Occupation since leaving school: -..........................................................................................................
13. Name and address of employer: -...........................................................................................................
………………………………………………………………………………………………………………………………………………….……….
14. Indicate if you are still employed or not: -..............................................................................................

SECTION V: PARTICULARS OF PARENTS/GUARDIANS:

15. Nationality of parents: Father: -.........................Mother: -........................Guardian: -...........................
16. Names and Addresses of:-
Father’s Name: -..................................................... Address: -...............................................................
………………………………………………………………………………………………………………………………………………………….
Mother’s Name: -................................................................ Address: -...................................................
………………………………………………………………………………………………………………………………………………………….
Guardian’s Name: -............................................... Relationship: -..........................................................
Address: -...................................................…………………………………………………………………………………………

17. On a separate paper, write an essay of one (1) page about your life history and why you want to
train and become a nurse.
18. Please attach three (3) certified copies of your Grade 12 Certificate and National Registration Card.
19. Attach an application letter.

Name of Applicant: - ………………………………………………….…………….

Signature of Applicant: -.............................................................
Date: - ......./......./20...... Contact # +2607 70980556 watsap
+26095 8415637
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