Online Application Form – Medicare College of Applied Sciences

Online Admission Form

DEGREE AND DIPLOMA PROGRAMME ADMISSION FORMS

MEDICARE COLLEGE OF APPLIED SCIENCES ADMISSION FORMS.

FORM NUMBER

Surname

First Name

Other Names

Passport Picture

Gender

Male Female

Date of Birth

Age (yrs)

Postal Addres

Permanent Residential Address

Fax

Telephone No(s)

NATIONALITY

HOMETOWN

REGION

FATHER’S NAME

FATHER’S ADDRESS

FATHER’S TELEPHONE No (s)

MOTHER’S NAME

MOTHER’S ADDRESS

MOTHER’S TELEPHONE No (s)

SENIOR HIGH SCHOOL ATTENDED

PROGRAMME PURSUED AT SHS

GRADES IN THE SUBJECTS

CORE SUBJECTS

ENGLISH

INTEGRATED SCIENCE

MATHEMATICS

SOCIAL STUDIES

ELECTIVE SUBJECTS

ELECTIVE SUBJECT 1

ELECTIVE SUBJECT 1 GRADE

ELECTIVE SUBJECT 2

ELECTIVE SUBJECT 2 GRADE

ELECTIVE SUBJECT 3

ELECTIVE SUBJECT 3 GRADE

ELECTIVE SUBJECT 4

ELECTIVE SUBJECT 4 GRADE

COPY OF RESULT SLIP(S)

PROGRAMME OF CHOICE

OTHER COURSES

HEALTH INFORMATION MANAGEMENT (HIM)(Not available)

PHARMACEUTICAL SCIENCE (HND) FOR SCIENCE STUDENTS ONLY(Not available)

FASHION DESIGN AND TECHNOLOGY (HND) FOR ARTS, BUSINESS, HOME ECONOMICS AND SCIENCE STUDENTS.(Not available)

HEALTH ASSISTANT OR NURSING ASSISTANT (Certificate) FOR ARTS, BUSINESS, HOME ECONOMICS AND SCIENCE STUDENTS(Not available)

STUDY OPTION

CATEGORY OF STUDENT

SHS (WASSCE) MATURE

RECOMMENDATION LETTER (MATURE STUDENTS ONLY)

NB: Mature student applications must be accompanied by a recommendation letter from Head of Department of current place of employment or two (2) referees who have known applicant for at least three years.

NAME OF GUARANTOR

PROFESSION

ADDRESS

HOW LONG I HAVE KNOWN THE APPLICANT

DECLARATION

I declare that the above information is a true reflection of my personal and academic background. I will comply by the rules and regulations governing the above institution and be subject to all sanctions prescribed for any offence committed. I submit myself to any appropriate official sanctions if any of the pieces of information given above is found to be untrue.

MEDICARE COLLEGE OF APPLIED SCIENCES MEDICARE COLLEGE OF APPLIED SCIENCES

DEGREE AND DIPLOMA PROGRAMME ADMISSION FORMS

MEDICARE COLLEGE OF APPLIED SCIENCES ADMISSION FORMS.

GRADES IN THE SUBJECTS

OTHER COURSES

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