UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE Tel. No.

+ 255-22- 2120261- 7 Fax: + 255-22 - 2138060 (All Correspondence to be Addressed to the Permanent Secretary

P.O. BOX 9083, DAR ES SALAAM

APPLICATION FOR PRE-SERVICE COURSES FOR ACADEMIC YEAR 2013/2014 INSTRUCTIONS TO ALL APPLICANTS: (a) None refundable application fees of TShs 15,000 should be paid for each application form submitted to the zone/centre. The money should be deposited in the Health Service fund Account No. 0111-030-12059, National Bank of Commerce, CORPORATE BRANCH. (b) Each application form is meant for one course (c) Attach the following items to the application form: i. One recently passport size photograph ii. Original Bank pay-in slip iii. Certified copies of Ordinary/Advanced secondary certificate, Leaving Secondary Certificate (d) Applicants completed their secondary school education outside the country should attach their birth certificates and equivalent qualifications obtained from the National Examination Council of Tanzania, for their academic certificates. (e) This form is available on the Ministry of Health and Social Welfare website - www.moh.go.tz (f) Submit your application form to the nearby Zonal Health Resource Centres (ZHRC) before 30/6/2013 (g) The academic year will commence on 14th October, 2013 List of courses available for academic year 2013/2014: A. Diploma Courses: i. Diploma in Clinical Medicine (Clinical Officer) ii. Diploma in Dental Laboratory Technology iii. Diploma in Dental Therapy iv. Diploma in Environmental Health Sciences (Assistant Health Officer) v. Diploma in Nursing vi. Diploma in Physiotherapy vii. Diploma in Optometry viii. Diploma in Medical Laboratory Technology Off campus B. Certificate Courses: (i) Certificate in Clinical Medicine (Clinical Assistants) (ii) Certificate in Medical Laboratory Technology (iii) Certificate in Nursing (iv) Certificate in Health Record Technology Admission requirements for pre-service candidates: A: Diploma Courses: 1. A candidate must have completed Secondary School Education 2. Applicant must pass ALL Science subjects with a minimum of C PASS in Chemistry and Biology and D in Physics for certificate for secondary education (O Level), OR Principal E B in ALL science subjects (Physics, Chemistry and Biology) as minimum entry qualifications for form Six applicants (A Level). B: Certificate Courses: Applicant must have passes in ALL science subjects with a minimum of D PASS specifically in Physics, Chemistry and Biology. Other requirements: Passes in Mathematics and English language is an added advantage for both Diploma and certificate courses. Eligible applicants must have completed secondary education from 2008 or above. Mode of Application: All applications should be properly filled in and submitted to Zonal Health Resource Centres (ZHRC) through the following addresses:

MoHSW application form Pre- service courses 2013/14

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a) b) c) d) e) f) g) h) i) j) k)

Zonal Coordinator, Eastern Zone (Morogoro and Coast Regions) Public Health Nursing School, P.O.Box 1060, Morogoro - (EZ) Zonal Coordinator, Western Zone (Kigoma and Tabora Regions) Clinical Assistants Training Centre, P.O.Box 458, Kigoma - (WZ) Zonal Coordinator, Southern Zone (Lindi and Mtwara Regions) Clinical Officers raining Centre, P.O.Box 86, Mtwara (SZ) Zonal Coordinator, Northern Zone (Arusha, Kilimanjaro, Manyara and Tanga Regions) Centre for Health Personel Education Development, P.O.Box 1162, Arusha - (NZ) Zonal Coordinator, South Western Highlands Zone, (Mbeya and Rukwa regions) Assistant Medical Officers Training Centre, P.O.Box 1142, Mbeya - (SWHZ) Zonal Coordinator, Southern Highlands Zone (Iringa and Ruvume Regions) Primary Health Care Institute, P.O.Box . 235, Iringa - (SHZ) Zonal Coordinator, Central Zone (Dodoma and Singida Regions) Mirembe Nursing School, P.O.Box 595, Dodoma (CZ) Zonal Coordinator, Lake Zone (Kagera, Mara, Mwanza and ShinyangaRegion) Chuo cha Madaktari Wasaidizi, P.O.Box 11351, Mwanza - (LZ) Director, Institute of Allied Health Scinces, P.O.Box 65005, Dar-es-salaam - (EZI) Principal, Clinical Officers Training centre, P.O.Box 30282, Kibaha - (EZK) Principal, Assistant Medical Officers Training centre P.O.Box 5030, Tanga. (NZT)

The applicant must indicate on the Bank Pay-in Slip the zone code to which the application form will be submitted e.g NZT for Tanga Centre, LZ for Lake zone. All application forms will be processed at the zones and centres mentioned in a to k above.

Issued by: Permanent Secretary, Ministry of Health and Social Welfare, P.O.Box 9083, Dar es salaam.

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UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE

For Official Use only: 1. ID No:............................ 2. Zone Code: .................... 3. District Code: ............
PHOTOGRAPH

Tel. No. + 255-22- 2120261- 7 Fax: + 255-22 - 2138060 (All Correspondence to be Addressed to the Permanent Secretary

P.O. BOX 9083, DAR ES SALAAM In

Reply please quote: Ref. No. JB. 69/558/01 APPLICATION FORM FOR PRE-SERVICE COURSES ACADEMIC YEAR 2013/14 Instructions: Fill items 1-16 below. Write legibly using blue or black ball point pen, and in CAPITAL LETTERS First Name 1. Full Name 2. Sex: 3. Nationality: 4. Date of birth: 5. Place of Birth (District): Middle name: Surname

6. Place of domicile (Home District): 7. Name of Secondary School attended Form Four (O level): 8. Year of completion of Form Four National Examinations: 9. National Form Four Examination Index Number: 10. Name of secondary school attended Form Six (A Level) 11. Year of completion of Form Six and Examination Number: 12. Indicate grades scored for each of the following subjects in the National Form Four Examinations: Physics: Chemistry: Biology: Mathematics: English:

13. Indicate grades scored for each of the following subjects in the National Form Six Examinations: Physics: Chemistry: Biology:

14. Mention the name of the course (one course only) you are applying for:

15. Applicants correspondence address: Postal address: Phone number: Email:

16. Applicants declaration: I declare that the information I have provided in this form is true. I understand that presentation of wrong information will lead to disqualification of application and legal action against me. Applicants signature: Date:

MoHSW application form Pre- service courses 2013/14

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