MINISTRY OF HIGHER EDUCATION KABWE INSTITUTE OF …

MINISTRY OF HIGHER EDUCATION

KABWE INSTITUTE OF TECHNOLOGY

(Formerly known as Kabwe Trades Training Institute)

P .O. BOX 80430 Kabwe, ZAMBIA

Tel : 260-21-5-223938, Cel l Phone No : 0977 451115/ 0977 410852,

Email : kabweit@yahoo.co.uk Website: kit.edu.zm

BACHELOR OF EDUCATION IN INFORMATION AND COMMUNICATION TECHNOLOGY

APPLICATION FORM

1. Surname .................................................................. 2. First Name ..........................................................

3. Middle Names ................................................................................................................................................

4. Residential Address .......................................................................................................................................

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

5. Present Mailing Address ................................................................................................................................

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

6. Email ........................................................ 7. Cell Phones .............................................................................

8. Marital Status Single

Married

Widowed

9. Gender : Female

Male

10 Date of Birth: Day

Month

Year

11. Nationality ............................ 12. Citizenship .............................. 13. N.R.C. No. ....................................

14. Passport No. ......................... 15. Issue Date ............................. 16. Expiry Date...................................

17. Name of Spouse/Next of Kin ...........................................................................................................................

18. Phone/Cell Nos.................................................... 19. Email ..........................................................................

20. Mailing Address ................................................................................................................................................

21. Name of Guardian/Sponsor............................................................................................................................

22. Phone/Cell Nos.................................................... 23. Email ..........................................................................

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24. Education Background

"O Level or equivalent examination passed and Grades attained.

Examination Body

Subject

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

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

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

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

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

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

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

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

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

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

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

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

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

Grades

Degree/Diploma/Certificate .................................................................................................... ................................................................................................... ..................................................................................................... .....................................................................................................

Awarding Institution .................................................................. ..................................................................... ...................................................................... ......................................................................

Mode of Study Full time

Part time

Distance Learning

25. Do you have any physical or communication disabilities?

Yes

please tick as applicable.

A. 1. Vision

2. Mobility

3. Speech

4. Hearing

5. Other

No. If answer is Yes

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B. If you have a disability that is not listed above, give details ............................................................... .......................................................................................................................................................................

26. EMPLOYMENT BACKGROUND Fill this part if you are presently employed; (a) Type of employment or job ........................................................................................................... (b) Name of employer .......................................................................................................................... (b) Address of employer .................................................................................................................... (d) Period of service ............................................................................................................................ (e) TS/Employee's Reference no.......................................................................................................

Signature of Applicant...........................................................

Date:..............................................

For Official use only

Institute's recommendation

Accept

Reject

Reasons for Rejection ............................................................................................................................................................................................ ............................................................................................................................................................................................ ............................................................................................................................................................................................ ....................................................................................................................................................................

Please send your duly completed application form with certified photocopies of NRC, Form V/Grade 12 and any other certificates to the Principal, Kabwe Institute of Technology, P.O. Box 80430, Kabwe. kabweit@yahoo.co.uk

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