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FOR OFFICIAL USE ONLY3.0 EDUCATION BACKGROUND AND EMPLOYMENT RECORD ALL.SEC.SCHOOLS ATTENDED LOCATION DATES FROM (MO/YR) TO (MO/YR) CERT.INDEX NO 3.1 University/College Education Have you attended this University/College or any other Institutions of Higher Learning before? Yes: No: If yes, provide details in the table below. S/N Institution Attended Status (Graduated/ discontinued/Absconded) If graduated give qualification attained Date Obtained Total number of years of schooling ……………….years ……….months……………………….. 3.2 Employment Record Please give details of your employment record in the table below. S/N Name of Employer Post Held Dates 4.0 Programme Sought in Order of Preference(Select from the list attached) Order of Preference Faculty Programme Code Full Name of Programme 1 st Choice 2 nd Choice 3 rd Choice 5.0 Language fluency: Language Spoken Written Fair Good Very good Fair Good Very good Academic year 2011‐2012 6.0 Referees Names and addresses of two referees who know your ability as a student and can assess your competence in written and spoken English (a) Full Name: ….………………..……....………………………………………..……………….………. Address:….………………..……....………………………………………..……………….………….. (b) Full Name: ….………………..……....………………………………………..……………….………. Address:….………………..……....………………………………………..……………….…………… 7.0 Sponsorship The sponsor should indicate here that the candidate would receive financial support for years he or she will spend at St.Augustine University. Name of sponsor: …....………………………………………..……………….……………………………… Address: ….………………..……....………………………Tel …………………………………….. Business OR Activity ….………………..……....……………Fax/ E-mail………………………….. I …………………………………………………..confirm that my Organization will give full financial support to…………………………………………………………………During the period of his/her education at St.Augustine University if he/she is accepted. Date ……………………………….signed…………………………………………. Official stamp or seal Declaration I declare that all information given in this form is correct. Signature of Applicant: …………………....………. Date.………………………………………….……… 8.0 PAYMENTS. Your non-refundable application fee of Tshs 20,000/= or US $ 25 should be paid to St. Augustine University of Tanzania via Bank Account number: 015101001461 NBC Ltd. Mwanza Branch (No Cheques are accepted) 9.0 ATTACHEMENTS. Please include the following with this application: (a) A medical Doctor’s Certificate stating that you are fit to follow this course. (b) Two (2) passport size photos of yourself (Colored). (c) A short history of your life in English (500-750 words or two fullscap) in your own handwriting, describing the important details of your life, your reasons for pursuing this courses of studies, and your plans for the future. (d) Photocopies of your school certificates OR results slip (Form IV and Form VI). (e) Birth certificate (f) Original pay slip of Tshs 20,000/= (for Tanzanian) or $ 25 (for Foreigner) When you have attached all required materials and have included certification of sponsorship (below) kindly send this to the office of the: (Please do not send by fax/E-mail) Admissions Office, St. Augustine University of Tanzania, P.O Box 307 Mwanza, Tanzania. ST. 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