Online Course Application Please enable JavaScript in your browser to complete this form.Application and Payment Instructions After completion of your application, kindly make payment for the processing to proceed. Put your Application ID below as transaction reference number. Payment Information: Bank: CRDBA/C: 0150650553000 Account Name: MacWish COHAS Application fee: Tsh 15,000 Application ID.Keep this number for future referencesSECTION 1: APPLICANT DETAILSFirst Name *Second Name *Surname *Date of Birth *Place of BirthNationality *Gender *MaleFemaleNo. of ChildrenDisabilityNoYesIf you have disability mention itMarital Status *SingleMarriedDivorcedWidow/WidowerPermanent Home AddressAddress Line 1Address Line 2CityState / Province / RegionPhone *Email *Close Relative InformationRelative Name *FirstMiddleLastRelative AddressAddress Line 1Address Line 2CityState / Province / RegionRelative Phone *Relative EmailRelative Relation *ParentGuardianOtherSECTION 2: PROGRAMMES OFFEREDProgramme *Clinical Medicine (NTA 4-6) ProgrammePharmaceutical Sciences (NTA 4-6) ProgrammeDiagnostic Radiography (NTA 4-6) ProgrammePlease select oneSECTION 3: EDUCATION BACKGROUNDPrimary School InformationPrimary School NamePrimary School Year of CompletionSecondary School InformationSecondary School NameSecondary School Index NumberSecondary School Year of CompletionSecondary School DivisionDivision OneDivision OneDivision TwoDivision ThreeDivision FourSubjects and Grades:PhysicsChemistryBiologyMathematicsEnglishHistoryGeographyCivicsKiswahiliPhoneSubmit
