“HOLISTIC FORMATION OF YOUNG PEOPLE INSPIRED BY THE VALUES OF THE GOSPEL”

APPLICATION FORM FOR ENROLMENT IN FORM FIVE 2018-19

(Fill and return this application form to school)

This form costs 15,000/-Tsh only.

Official Name ______Address P.O. Box ______

(Use the exact name used for your Form Four National Examinations)

Ward/Location______District ______Region ______

Sex _____Tribe ______Date of Birth ______Age ______

(as on your Birth Certificate)

Dini ______If Christian, specify Denomination ______

Form Four School Name______Year of completion______

Country where you completed form four ______

Form Four Results: Year ______Division ______Points ____ No of Credits (A/B/C) ______

Form Four Resit (If applicable): Centre Name: ______Country ______

Year______Division______Points______No of Credits (A/B/C)______

Subjects with Credit (A, B+, B or C) please circle:

BiologyBookkeeping Chemistry CivicsCommerceEnglish Eng Lit

GeographyHistory Kiswahili Mathematics Physics Agriculture Food & Nutrition

French Other ______

Preferred Combination

Select three combinations according to your preference from the listed below that you would like to take. Ensure that Ensure that the combinations you are selecting have at least two credits (A, B, & C) and one D in the subjects. Strictly no ‘F’ in the combination.

CBA, CBG, CBN, ECA, EGM, HGE, HGL, HGK, HKL, KLF, PCB, PCM, PGM

First choice ______Number of credits______in the combination______Number of Dsin combination______

Second choice ______Number of credits in combination______Number of Ds in combination______

Other Interests (ie other than study, how do you spend your time – eg sports, music, activity, etc)

STUDENT ACCOMMODATION: Boarding is first given to those with high academic performance

Please circle your choice

BOARDING / DAY

I would like to be offered

YES / NO

In case you have chosen boarding would you accept day if offered?

FAMILY INFORMATION

Name of Father/Guardian______Telephone______

Ward______District ______Region ______

Name of Mother/Guardian______Telephone______

Ward______District______Region______

Email contact (if available): ______

RECOMMENDATION FROM PREVIOUS SCHOOL: Name of Applicant ______

Please comment upon the academic ability and conduct of the applicant to this Catholic School.

______

______

Signed: ______Date: ______Role: ______

School Stamp

TERMS AND CONDITIONS OF ADMISSION:

Name of Student: ______Name of Parent or Guardian:______

We, the above mentioned people, do hereby apply for admission into Form _____ for the academic year 2018-2019.

The student promises to adhere to all regulations and directions of the school and accepts the right of the management of the school to terminate her/his studies at the school in the event of any breach of school rules and directions or failure to honour financial obligations to the School. The parent/guardian undertakes to ensure that she/he will cooperate with the school to assist the student to complete her/his studies.

Signed: Student ______Parent or Guardian ______Date ______

Contacts: School Office (office hours only): 0753 860 477

School Email:

Registrar (for enrolment matters only): 0754 914 018 or

Website: