APPLICATION FORM FOR ADMISSION INTO PROFESSIONAL COURSES AND PROGRAMMES

A. Bio Data:

Name

Othe Name

Surname

Gender

Date of Birth

Marital Status

State of Origin

LGA

Home Town

B. Contact Information:

Home/Office/P. O. Box:

Town:

LGA

State/Country

Telephone

C. Next of Kin Information:

Full Name:

Relationship:

Email Address:

Phone Number:

Residential Adress:

D. Choice of Program:

i. Available Course(s) in Health Care Administration and Hospital Management;

Take Note: Tick ✓ boldly your choice of program.

S/N	Available Course(s)	Duration	Requirement(s)
1.	Certificate in Health Care Administration and Hospital Management.	Three (3) months	Five (5) O' level credit in any discipline, health managers and administrators, public and private hospital and related workers.
2.	Diploma in Health Care Administration and Hospital Management.	Six (6) months	Five (5) O' level credit in any discipline, managerial certificate from any discipline. health managers and administrators, public and private hospital and related workers. holders of the certificate in health care administration and hospital management.
3.	Advanced Diploma in Health Care Administration and Hospital Management.	Nine (9) months	Five (5) O' level credit in any discipline, managerial diploma from any discipline. health managers and administrators, public and private hospital and related workers. holders of the diploma in health care administration and hospital management.
4.	Professional Postgraduate Diploma in Health Care Administration and Hospital Management.	One (1) year	Health related ND/HND/BSc, health care workers, managers and administrators, public and private hospital and related workers, holders of the advanced diploma in health administration and hospital management.

Choose Course in Health Care Administration

ii. Available Course(s) in Field Epidemiology Practice;

Take Note: Tick ✓ boldly your choice of program.

S/N	Available Course(s)	Duration	Requirement(s)
1.	Certificate (Basic) in Field Epidemiology Practice.	Three (3) months	Workers serving in the one-health and related sectors, at least O' level credit passes, one Health Ministry (Health, Environment, Laboratory, Veterinary) workers, plus letter of support.
2.	Intermediate Course (PGD) in Field Epidemiology Practice.	Nine (9) months	Health related ND/HND/BSc, holders of the Basic FETP certificate, plus letter of support.

Choose Course(s) in Field Epidemiology Practice

iii. Available Course(s) in Health Assistance and Care Giving;

Take Note: Tick ✓ boldly your choice of program.

S/N	Available Course(s)	Duration	Requirement(s)
1.	Certificate Course in Health Assistance and Care Giving.	Three (3) months	Three (3) O' level credits.

Choose Course in Health Assistance and Care Giving.

E. Academic History with Date(s):

List all Acadmic history in this format

1.
School/Institution(s) Attended: eg: Adeyemi College of Education
Degree/Certificate(s): Bsc Chemistry Education
Date(s): 12 June, 2012.
Grade: 3.5

Academic history

F. Certification Statement:

I ………………………………………………………………………...hereby solemnly declare that the information provided by me in this form is genuine, accurate and complete. I understand that any false or misleading information may lead to rejection of my application or future consequences. I affirm that the details provided are true and reflect my personal and academic history accurately.

Full Name

Signature

Date

APPLICATION FORM FOR ADMISSION INTO PROFESSIONAL COURSES AND PROGRAMMES

D. Choice of Program:

i. Available Course(s) in Health Care Administration and Hospital Management;

ii. Available Course(s) in Field Epidemiology Practice;

iii. Available Course(s) in Health Assistance and Care Giving;

Useful Links

Useful Links

Hours of Operation