First name

Middle Name

Last Name

Gender Gender *malefemale

Date of Birth

Nation ID/passport number

Nationality

Phone Number

Email Adress

Program of Interest (1st option) Program of Interest (1st option) *Diploma in nursingDiploma in midwiferyPublic Health NursingOperating Theatre NursingHIV Nurse PractionerTrauma and Emergency NursingCritical care NursingRegistered Neonatal NursingPeadiatric and Child Health NursingClinical Instructor NursingBachelor of Science in Critical Care NursingBachelor of Science in Emergency and Trauma Nursing

Program of Interest (2nd option) Program of Interest (2nd option) *Diploma in nursingDiploma in midwiferyPublic Health NursingOperating Theatre NursingHIV Nurse PractionerTrauma and Emergency NursingCritical care NursingRegistered Neonatal NursingPeadiatric and Child Health NursingClinical Instructor NursingBachelor of Science in Critical Care NursingBachelor of Science in Emergency and Trauma Nursing

Program of Interest (3rd option) Program of Interest (3rd option) *Diploma in nursingDiploma in midwiferyPublic Health NursingOperating Theatre NursingHIV Nurse PractionerTrauma and Emergency NursingCritical care NursingRegistered Neonatal NursingPeadiatric and Child Health NursingClinical Instructor NursingBachelor of Science in Critical Care NursingBachelor of Science in Emergency and Trauma Nursing

Study Mode Study Mode *On-CampusDistance Learning

Highest Qualification Highest Qualification *Secondary SchoolDiplomaDegree

Year of Completion

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