EAST AFRICAN INSTITUTE OF HOMECARE MANAGEMENT
Internal & Trade Test Students — Admission Form
Student Identification
ADM NO
*
FULL NAME
*
GENDER
*
Select
Male
Female
Other
DOB
NATIONAL ID/BIRTH CERT
NATIONALITY
PWD
Select
Yes
No
LOCATION
Contact Details
PHONE NUMBER
EMAIL ADDRESS
GUARDIAN NAME
GUARDIAN PHONE NUMBER
Programme Details
DEPARTMENT
*
Select department
COURSE
*
Select department first
INTAKE YEAR
INTAKE MONTH
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Jan
May
Sep
EXPECTED MONTH/YEAR OF COMPLETION
NITA
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yes
No
Sponsorship
SPONSORSHIP TYPE
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Self Sponsored
Government Sponsored
NGO/Organization Sponsored
Agency/Employer Sponsored
Family Sponsored
Bursary/Grant
Other
SPONSOR NAME/ORGANIZATION
SPONSOR CONTACT
Status (leave blank on first entry, update later)
COMPLETION STATUS
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Ongoing
Complete
Dropout
GRADE
Select
Distinction
Credit
Pass
Fail
WORKING STATUS
Select
Employed
Self Employed
Internship
Attachment
Unemployed
Submit