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Application Form
Full Name
Date of Birth
Form IV Index Number
Format: S1234/5678/2020
National ID
NHIF Member ID
Phone Number
Example: 0712345678
Email Address
Physical Address
Course Applying For
Select Course
Diploma in Nursing and Midwifery
Diploma in Clinical Medicine
Certificate in Medical Attendant
Form IV Certificate (PDF)
Max 5MB (PDF, JPG, PNG)
Result Slip (PDF)
Max 5MB (PDF, JPG, PNG)
Birth Certificate (PDF)
Max 5MB (PDF, JPG, PNG)
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