MUKUNI UNIVERSITY INSTITUTE OF HEALTH SCIENCES

EVERGREEN COLLEGE OF HEALTH AND SOCIAL SCIENCES STUDENT APPLICATION FORM

Fill out the form carefully To successfully register for January/February 2022 Intake
Physical Location: Kalungwishi Street Nkana East, Kitwe Copperbelt
Student Name*

First NameLast Name
Student Birth Date

MonthDayYear
Gender
Your Physical Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address

Will Be Sending You Important Emails and Educational Resources Regularly, Therefore We Highly Recommend our Prospective Students To Have One Or Create One (Watch YouTube video) e.g. Gmail/Yahoo. example@gmail.com
Student Email Address Very Important*
Notice:This is were will send the Acceptance Letter
Mobile Number*

type 260Phone Number
Offered Program For January February Intake*
Select The Intake You would Love To study With Us for 2022*
National Registration Card & Grade 12 And GCE Results

These Documents Will Help Us Enroll You Instantly But Note that GCE students are accepted
Upload Your Scanned NRC

Upload NRC
Pdf Or Picture Cancelof
Upload Your Grade 12 Certificates/Result Slip.

Upload 12 Results
Both External Or Internal Results Cancelof
Additional Comments
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EVERGREEN COLLEGE OF HEALTH AND SOCIAL SCIENCES STUDENT APPLICATION FORM