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Zamcom Application Form A4d

This document contains an application form for Zambia institute of mass communications educational trust. It requests information such as proposed course of study, contact details, next of kin, employment details, and how the applicant learned about Zamcom's programs. The applicant must declare that the information provided is true and pay a non-refundable application fee of K150. The form will then be processed and the applicant will be notified if they have been approved or not approved for their proposed course of study.

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collins bwali
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116 views

Zamcom Application Form A4d

This document contains an application form for Zambia institute of mass communications educational trust. It requests information such as proposed course of study, contact details, next of kin, employment details, and how the applicant learned about Zamcom's programs. The applicant must declare that the information provided is true and pay a non-refundable application fee of K150. The form will then be processed and the applicant will be notified if they have been approved or not approved for their proposed course of study.

Uploaded by

collins bwali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Zambia institute of mass communications educational trust

Tel: +260 211 251 811 P.O. Box 50386, Lusaka, Zambia
Email: [email protected] www.zamcom.co.zm

Application form K150 (NON REFUNDABLE)


MODE OF STUDY

FULL TIME PART TIME DISTANCE

PROPOSED COURSE OF STUDY

.............................................................................................................................................................................................

Application information
Surname: ........................................................................... First Name: .......................................................................

Other Names: ....................................................................................................................................................................

Gender Male Female (Please tick where appropriate)

Residential Address: .........................................................................................................................................................

.............................................................................................................................................................................................

Email Address: ..................................................................................................................................................................

Mobile Nationality: .................................................................

NRC Date of Birth D D M M Y Y Y Y

Place: ................................................................................. (Optional)


Religion: ............................................................................

Next of Kin: ........................................................................................................................................................................

Address: ............................................................................................................................................................................

....................................................................................... Mobile

Name of Sponsor: .............................................................................................................................................................

Address: ............................................................................................................................................................................

....................................................................................... Mobile

(If any)
State any physical disability or serious illness: .............................................................................................................
Employment (If applicable)

Job Title: ............................................................................................................................................................................

Company: ...........................................................................................................................................................................

Postal Address: ..................................................................................................................................................................

.............................................................................................................................................................................................

How did you know about zamcom programs? (Please tick where appropriate)

TV Radio Newspaper School Friends / relatives

Others (Please Specify): ...................................................................................................................................................

Declaration

I do declare that the information provided in this form is true and correct to the best of my knowledge.

Signature: ........................................................................... Date D D M M Y Y Y Y

for Official use only

Decision:
Approved Not Approved

Reason(s) for non approval: ....................................................................................................................................

.............................................................................................................................................................................................

Processed by: .................................................................................................................................................................


(This student is duly registered with ZAMCOM)

Signature: ........................................................................... Date D D M M Y Y Y Y


ACADEMIC COORDINATOR

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