Tel.:027-2503040/2075/2076 Fax No: 027 254 8337 P. O. Box 296, Arusha, Tanzania Junction of Moshi-Arusha and Nairobi Roads Email: principal@atc.ac.tz Website: http://www.atc.ac.tz
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Application for Ordinary Diploma Courses offered by Arusha Technical College in the 2013/2014 Academic Year
Please make sure that you read and understand the admission information provided on the advert before filling the admission form. All fields in this admission form are compulsory
1.0
ENTRY SCHEME Please tick () the entry scheme you applying for: ENTRY SCHEME Direct Entry Scheme CHOICE
TRAINING PROGRAME
Mature Age entry Scheme Pre. Entry Scheme (Access Course) NVA Bridging Course
2.0
PREFERENCES Please enter your preferences (1, 2, 3) in the choice column (Only three choices) S/No 1 2 3 4 5 6 7 8 9 10 11 12 TRAINING COURSES Auto-Electric & Electronics Engineering Automotive Engineering Civil Engineering Civil & Irrigation Engineering Electrical Engineering Electronics & Telecommunications Engineering Mechanical Engineering Transportation Engineering Laboratory Sciences and Technology Computer Science Information Technology Electrical and Biomedical Engineering CHOICE
3.0
APPLICANT
PARTICULARS
Please use capital letters 1. Surname First Name 2. 3 4. 5. 6. 7. Other Name s Sex . Date of Birth Pl ace of Birth . . Citizenship .. . Religion . . Marital Stat us . Contact Address . . Telephone Number ..
8.
9. E-mail ..
(i)
(a) Date of completion of Secondary Education or GC E (b) Examination Index Number . (c) Examination Results (Fill the table below)
B AS I C S UB J E CT GRADE OTHER SUBJ ECTS GRADE
Examination Authority .
(e) Division/grade . (f) Examination Center/School . (g) Country (ii) Advanced Certificate of Secondary Education Examination (ACSEE) or Other Course in Science/ Engineering e.g. VETA.
(a) Date of completion of A-Level or Other course (b) Examination Index Number . (c) Examination Results (Fill the table below)
SUB J ECTS GRADE SUB J ECTS GRADE
(d) Examination
A u t h o r i t y .
.
(e) Division/grade/NVA
4.0PHYS ICAL FITNESS Do you have any physical or Communication Disability e.g. Vision, Mobility, Speech, hearing or others? (Please tick) Yes No If yes please give deta ils ..
5.0 DE CLARATION I .. (Name) declare that the information given in this form is correct. S ignature of applicant . Date ..
NOTE: This application form will not be processed unless it is accompanied by original receipt/pay- in slip showing the payment of application fees of 20,000TZS paid to NMB Bank: The pay-in slip must show the name of applicant Account Name Account Number TCA S tud en ts S ervices Accou n t, 4082517105.