Instruction DABAGA INSTITUTE OF AGRICULTURE (DIA) Invites applications from qualified persons to apply for admission into its Certificate course programme for the 2023/2024 Academic year. Applicant wishing to be enrolled should send his/her duly filled application form to the above postal or E-mail address or return it to the Institute directly for consideration. Select a course you are applying for: —Please choose an option—Certificate in Animal Health and ProductionCertificate in Agriculture Production Attach copies of relevant Academic certificates, transcripts and Birth certificate. Attach also a copy of your pay-in slip for this application (i.e. Tshs.30,000/=of which Tshs. 20,000/=is for NACTEVET registration and Tshs.10,000/= for transactions at the Institute) Tuition fee for Certificate Courses is Tsh.1,600,000/= and will be paid in four (4) installments through NMB Bank Account named as DABAGA INSTITUTE OF AGRICULTURE, Account No.62310007709. Next Personal Information First Name Middle Name Last Name Sex: MaleFemale Marital Status Date of Birth Place of Birth Religion Nationality Permanent Address City/region Country Phone Number E-mail Address Are you disabled? YesNo BackNext B. EDUCATIONAL BACKGROUND Primary School Attended: Year of Completion: Secondary School Attended: Year of Completion: Index Number for first sitting: Index Number for re-sitting: Examination Center: Division and points: Examination Authority: Fill in the grades of your o-level subjects Chemistry: —Please choose an option—ABCDEF Biology: —Please choose an option—ABCDEF Agriculture: —Please choose an option—ABCDEF Physics: —Please choose an option—ABCDEF Nutrition: —Please choose an option—ABCDEF Geography: —Please choose an option—ABCDEF Mathematics: —Please choose an option—ABCDEF Engineering science: —Please choose an option—ABCDEF English: —Please choose an option—ABCDEF Kiswahili: —Please choose an option—ABCDEF Book keeping: —Please choose an option—ABCDEF Civics: —Please choose an option—ABCDEF History: —Please choose an option—ABCDEF Commerce: —Please choose an option—ABCDEF BackNext C. FINANCIAL SPONSOR Sponsor’s Name Occupation Postal Address Phone Number Fax number Email Address BackNext D. PEOPLE TO CONTACT IN CASE OF EMERGENCY FIRST PERSON Name Relation Postal address Phone number Fax number E–mail Address SECOND PERSON Name Relation Postal address Phone number Fax number E–mail Address BackNext E. Attachments Scan all your related certificates in one pdf file and upload below: Only files with .jpeg, pdf, zip, and jpg extension are allowed. Attach your bank payment slip of tshs: 30,000 registration fee. Only files with .jpeg, pdf, zip, and jpg extension are allowed. BackNext F. DECLARATION All the information provided here in is true to the best of my knowledge and belief. I agree to abide by the rules and regulation of the institute and program in which I shall be registered and any changes which may be made while I am at Institute. Your Initials: Back
