Computing Informatics (1)
Computing Informatics (1)
ADMISSION FORM
PERSONAL DETAILS
Surname……………………..................Other names………………………………………..
Sex………………………..Religion………………………..Mobile No……………………….
ID No………………............................................Nemis code………………………………………….
Sub-location………………………………………………Village………………………………………
Mobile No………………………….
CO-CURRICULAR ACTIVITIES
a) Sports………………………………………………………………………………
b) Hobbies…………………………………………………………………………….
c) Responsibility at school (if any)………………………………………………………………
d) Others………………………………………………………………………………
Applicant’s signature……………………………………..Date…………………….
Parent/Guardian’s name……………………………………………………………..
Signature………………………………………….Date…………………………….
MEDICAL EXAMINATION FORM
REF: STTI/ADM/2017
1) Full name…………………………………………………………………………
2) Sex………………..Age…………..Date of birth…………………………………
3) Marital status……………………….Number of children…………………..Ages of children
respectively……………………… ………………………… …… …. ………………
4) Do you suffer from any physical impairment/disability (e.g. paralyzed arm, loss of leg etc.)
……………………………………………………………………………...
5) Do you have any dietary restrictions?......................................................................
If so, give details……………………………………………………………………
6) Indicate your Blood group………………………………………………………….
7) Have you suffered from any of the following diseases:
• Tuberculosis YES/NO………………………..
• Typhoid YES/NO…………………………….
• Gonorrhea YES/NO…………………………..
• Syphilis YES/NO……………………………..
• Epilepsy YES/NO…………………………….
• Hernia YES/NO……………………………….
• Amoebic Dysentery YES/NO…………………
• Malaria YES/NO………………………………
• Fracture YES/NO……………………………..
The candidate is strongly reminded that the importance of supplying correct information cannot be
overemphasized and that each candidate will be held responsible for the accuracy of the information
he/she provides.
Student Name…………………………………………………………………..