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SUZA/DAQA/REG/001/0015 -16

Form No.

THE STATE UNIVERSITY OF ZANZIBAR (SUZA)

DEPARTMENT OF ACADEMICS & QUALITY AFFAIRS
Application Form for Undergraduate, Diploma and Certificate Courses
______________________________________________________________________________________________
This form is for Tanzanian and non-Tanzanian Undergraduate, Diploma and Certificate applicants.
It consists of 7 sections. To be duly filled and submitted before the deadline. Please read it carefully before filling.

SUZA currently offers Doctor of Medicine (MD), Bachelor in IT (BITAM), Bachelor OF Tourism Management and Marketing (BTMM)
Bachelor of Science and Information Technology with Education (BSc &IT-Ed) (3years), BA Edu, B.A Kisw with Ed., B.A Hist, B.A.
Geo, BSc (Edu), BSC Env. Health, BSc (Computer Science) programmes and University Qualification Frame Work Level Six (UQFL Level 6) in Science, IT & Computer Science. Other programmes are Diploma in Heritage Mgt & Tourism, Diploma in Library & Info.
Studies, Diploma in Languages with Education, Diploma of Science in Education, Dip. In Social Work, Diploma in Computer Science,
Diploma in Information Technology, as well as Diploma in Educational Leadership and Management. Diploma in Inclusive and
Special Need Education (ISNE), Diploma in Physical Education and Sports Sciences (PESS). Certificate Courses are Certificate in
Computing Technology and Certificate in Librarianship & Information Studies

USE CAPITAL LETTERS ONLY

Courses applying for (Please write down):First Choice: ...;
Second Choice: ....;
Academic year to be taken .;
1.0 SECTION A: PERSONAL DATA

1.1 Full Name ;

1.2 Other names (if any)................................................................................................................................;
1.3 Gender :

Male

Female

1.4 Place and Date of Birth: Place: ...Date...............................................................;

1.5 Marital Status:

Married

Single

Divorced

Widowed

1.6 Citizenship (Present)................................................................................................................................;

[If you have changed your nationality, state your previous citizenship]
.............................................................................................................................................................;
1.7 Type of needs (For Disable and people with special needs)
Do you have any physical disability? Yes.

No.

If Yes, Please mention ...;

1.8 Contact Address: ;
Telephone number............................................. Fax Number......;
E-mail

.....................................................................................................................................................;

Your permanent address if different from the above

Contacts Address: ;
Telephone number............................................. Fax Number ...........................................;
E-mail

.......................................................................................................................................................;

1.9 Your Next of kin (Person to be notified in case of any emergency).

His/ Her Full Name: ...............................................................................................................................;
Permanent Address Phone Number...................................................;
E-mail ....................................;
2.0 SECTION B: EDUCATIONAL BACKGROUND
(Attach your photocopied certificates. You will be required to produce original certificates OR
credential/document during interview/Registration)
Note: Photocopies should show clearly applicants names, centre and examination number, year of
examination and credits.

2.1Certificate of Secondary Education Examination (CSEE)/Form IV or Equivalent

Subjects

Grade

Year Taken

Index No

Division

1
2
3
4
5
6
7
8
9
11
School/ Centre ...;
Examination Authority (Eg NECTA) ;
2.2 Advanced Certificate of Secondary Education (ACSEE)/Form VI or Equivalent.
Subjects

Grade

Year Taken

Index No

Division

Points

1
2
3
4
5
7

School/ Centre ;
Examination Authority (Eg NECTA) .;
FOR B.A & BSC ED applicants write down your subject combination at degree eg, KISW/ENG,

CHEM/BIO, HIST/GEO etc

2.3 Qualifications Other than CSEE/ACSEE (Eg. Diploma, Degree etc).
Subjects

Grade

Year Taken

Index No.

Overall
Grade/GPA

1
2
3
4
5
6
7.
8.

School/ Centre .;
Examination Authority ;
3.0 SECTION C: EMPLOYMENT RECORDS
3.1 Are you employed/ self employed?

Yes

No

3.2 If Yes, Mention Name and Address of your current employer;

....;
3.3 Place of Work .....................................................................................................................................;
3.4 Your Designation ................................................................................................................;
3.5 How long have you been employed? YearsMonths..;
3.6 If you are admitted into this Programme, do you think your employer will release you?
3.7 If yes,

Yes

No

provide evidence. .;

For the employer:

3.8 I am ready to release Mr. /Ms/Mrs. . for his/her studies
in the . Academic year if he/she will get admission in this University.

Name and Status

Signature and Official stamp.

4.0 SECTION D: FINANCIAL GUARANTEE

4.1 Full Name and Address of Your Sponsor .;
Note: A supporting letter from your sponsor is required
4.2 Show Mode of Payment as, Full Payment
If No.

Yes

No

Pay in Two installments of US. Dollars/Tz. Shillings ..........................................................per installment.

5.0 SECTION E: DECLARATION

5.1 I................................................................................................................................. (Full Name)
5.2 Hereby certify that all the information in this form is mine and correct to the best of my knowledge at the time of
submission.
5.3 APPLICANTS SIGNATURE....................................................

DATE.................................................;

6.0 SECTION F: FOR OFFICIAL USE ONLY

6.1 General Comments: .;
.......;
6.2 The student has been accepted / not been accepted
6.3 Subject Combination; ...;
6.4 Name of the officer.......................................................................................................................;
6.5 Signature .................................................

Date...................................................;

7.0 IMPORTANT NOTES TO APPLICANTS

1. Please complete this MANNUAL Application Form as well as ONLINE form which is available in our website (the
forms are identical). The filled forms should be enclosed with all the required documents and submitted to the
nearest SUZA campus or send it to:
DEPARTMENT OF ACADEMICS & QUALITY AFFAIRS.
THE STATE UNIVERSITY OF ZANZIBAR
P.O.BOX 146, TUNGUU, ZANZIBAR - TANZANIA
Tel: +255242230724/2233337, Fax: +255242233337
Email: dvcacademic@suza.ac.tz , url:www.suza.ac.tz
If you have been awarded a scholarship, please attach a copy of the offer letter.
2.
3.
4.
5.
6.

Incomplete application form shall be considered null and void.

The decision made by the selection Committee is final.
On return of this form a copy of certificates and application receipt should be accompanied.
Application fees are non-refundable.
Submission of forged certificates/testimonials or any other false information is unlawful and will be handled
according to the law.
7. Degree programmes applicants are required to pay a non-refundable application fee of Tsh. 30,000/-, Diploma
20,000 and certificates 15,000. All payments to be paid through the People Bank of Zanzibar (PBZ) Limited,
Universitys account number 021103000490, and the original slip to be presented to the bursars office SUZA
for the issuance of official receipt.
8. Annual Fees for all courses which may be pay per semester: Certificate library 519,750, Cert.

computing 645,750, Pre Diploma Science 645,750, UQF L6 997,500, Diploma IT 813,750, Diploma Arts
with Education 519,750, Diploma Comp. Science 960,750, Diploma in Educational Leadership and Mgt
740,250, Diploma in Science with Education 960,750, Dip. In Heritage and Tourism Mgt, 1,013,250,
Dip. Social Work 918,750, Diploma in Inclusive and Special Need Education (ISNE) 1033250, Diploma
in Physical Education and Sports Sciences (PESS) 1033250, and Dip. in Library & inf. Studies
1,013,250. B.A/Bsc Ed. 1,433,250, Bsc Env. Health 2,273,250, B.A GEO. 1,748,250, B.A HIST.
1,748,250, Bachelor OF Tourism Management and Marketing (BTMM) Bachelor of Science and
Information Technology with Education (BSc &IT-Ed) (3years) 1453250, Doctor of Medicine
3,323,250, Bsc Comp. 1,590,750, BITAM 1,748,250, BSc Edu IT Major 1,433,250. Annual fees are
SUBJECT TO CHANGE.