Full Name *

Birth Date *

in G.C

Age *

Gender *MaleFemale

Nationality *Please select an optionEthiopianAbroad

Marital StatusSingleMarriedOther

Phone Number *

Email Address

Permanent Address *

City

Postal Code

Program *DegreeDiploma

(Degree) B.Sc. Program Applied ForBachelor of Science in NursingBachelor of Medical Laboratory ScienceBachelor of Public HealthBachelor of Health InformaticsBachelor of PharmacyBachelor of MidwiferyBachelor of Family Health

Diploma (TVET) Program Applied ForDiploma (TVET) Program Applied ForLevel IV Diploma in NursingLevel IV Diploma in Medical Laboratory TechnicianLevel IV Diploma in MidwiferyLevel IV Diploma in Health InformaticsLevel IV Diploma in PharmacyLevel IV Diploma in Emergency NursingLevel IV Diploma in Environmental Health ServiceLevel IV Diploma in Health ExtensionLevel V Diploma in Anesthesia

Mode of Study *RegularPrivate

Academic Year *

Student ID (If there)

High School Name *

Year 12th Completed *12th completed year (eg: 2016)

Highest Qualification Obtained

Relevant Certifications

Blood Group

Medical Conditions

Vaccination RecordAttachedNot Attached

Emergency Contact • Name *

Relationship

Contact Phone Number *

Contact Phone Number2

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Copy of Birth Certificate *

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Copy of National ID/Passport *

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High School Academic Transcripts *

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Grade Eight Result Certificate *

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Ethiopian Higher Education Entrance Certificate Examination *

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Passport-size Photographs *

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Medical Clearance Certificate

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COC Certificate

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Letter of Work Experience

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Application Fee

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Pay Application Fee 150 ETB to College's CBE Account Number: 1000021468057 & upload the slip.

Other Documents (If any)

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Are you currently employed *YesNo

Employing OrganizationGovernmentalNon-GovernmentalPrivate

• Name of Employing Organization

Organization Address

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Declaration *I hereby declare that all the information provided is true and correct to the best of my knowledge. I agree to abide by the rules and regulations of the College of Health Sciences.* Fields are mandatory

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