EduRole Student Information System

Application form for new students

You are requesting admission to the following programme: DIPLOMA IN MIDWIFERY-NEW
Please complete the following form entirely to successfully complete your application. Click on the steps below to continue.

1 - General information

In this section you will provide basic information needed for your enrolment.

Information	Input fields	Description
1.2 - National Registration Number		Please enter the ID number provided on your national identification card or passport
1.3 - Surname		Your family name
1.4 - First Name		Your given name
1.5 - Middle name		Optional
1.6 - Sex (Gender)
1.7 - Date of Birth		Minimum age for applicants is 16 years
1.8 - Nationality
1.9 - Streetname and number		For example: Munkoyo Street 1583
1.10 - P.O Box		For example: 804040
1.11 - City/Town
1.12 - Phone Number		For example: 0978168860
1.13 - Email Address		Optional (Yahoo, Hotmail, Gmail, etc)
1.14 - Country
1.15 - Disability
1.16 - Marital Status
1.17 - Study Delivery Mode

2 - School certificate examination results

Grade code	Grade code	Grade code
English Language	English Literature	Geography
Art	Agriculture Science	Commerce
Mathematics	Principles of Accounts	Phys. Science
Physics	Homecraft/Cookery	Gen. Science
Chemistry	French or Zamb.Language	History
Metal work	Religious Education	Music
Biology	Technical drawing	Computer Science
Civic Education	Other	Other 2

3 - Education background

4 - Next of kin information

5 - Sponsors information

6 - Second and third program choices

This is the final part of your admission request, here you will need to select your second and third choice program choices, should you not get picked for your main program.

Information	Selection
6.1 - Second Choice:
6.2 - Third Choice:

7 - Submit your application

Information	Input fields	REMOVE RECORD
0 3.1 - Type of certificate
1 3.2 - Name of institution		For example: Evelyn Hone
2 3.3 - Name of certification		For example: Grade 12, or Diploma in Business Studies
Scan of document		Upload the certificate, degree or diploma.

Information	Input fields	REMOVE RECORD
4.1 - Full Name
4.2 - Relationship
4.3 - Phone Number
4.4 - Email
4.5 - Address
4.6 - Town

Information	Input fields	REMOVE RECORD
5.1 - Full Name
5.2 - Sponsorship
5.3 - Phone Number
5.4 - Email
5.5 - Address
5.6 - Town