Online Application Form - North Western University College of Health and Applied Sciences

Today's Date*

Firstname*

Othernames*

Surname*

Gender*

Marital Status*

NRC*

Date of Birth*

Email Address*

Telephone*

Address Line 1*

Address Line 2

Town/City*

Postcode

Country*

NRC*

Bank Deposit Slip*

Mathematics*

English*

Science*

Science Grade*

Optional Subject 1*

Optional Subject 1 Grade*

Optional Subject 2*

Optional Subject 2 Grade*

Optional Subject 3

Optional Subject 3 Grade

Optional Subject 4

Optional Subject 4 Grade

Upload Scanned copy of Certificate*

Upload Scanned copy of Certificate

You can download our PDF Application form here.

Please ensure to complete and insert your copy of Certificate in ALL the “Upload Scanned copy of Certificate” boxes, if you only have 1 results slip then upload the same file in all 4 boxes