Gender: MaleFemale
Marital Status: SingleMarried
Date of Birth:
ParentUncleSpouseAuntyFriendNeighborOthers(Please Specify...)
My Parents(s)Brothers and SistersMy wife and HusbandRelativesMy ChildrenOthers.
YesNo
You answered " yes" which one? TuberculosisHepatitis BAsthmaticKidney DiseaseOthers (Please Specify...)
You answered "yes" which one? Visual ImpairmentIntellectual ImpairmentPhysical DisabilityAcquired Brain InjuryOthers (Specify.....)
PrimaryO'levelA'levelCertificateDiploma
CertificateDiplomaOthers
Certificate in MidwiferyCertificate in NursingDiploma in NursingDiploma in Midwifery
What are you planning to do after completing your course? Look for a jobGo on further educationBecome self employedContinue to do what I do nowNot sureother
Attach academic certification and recommendation letter accepted files (pdf | doc | docx | ppt |)
I here by apply for registration at Bugongi College of Nursing. If registered I under take to observe and abide by the rules and regulation governing students and candidates. I declare that the information on this form is true and correct to the best of my knowledge and i agree for my information to be shared by the BCNM and its partners in order to allow monitoring evaluation and reporting.
