ROYAL ANN COLLEGE OF HEALTH - RACOH

1 ROYAL ANN COLLEGE OF HEALTH ATWIMA MANHYIA P. O. Box KS 6253, Kumasi WEBSITE: ADMISSION APPLICATION FORM SANDWICH PROGRAMME diploma In medical laboratory Technology (MLTCP) DETAILS Surname (Family Name).. First Name(s).. Former Name (If applicable).. Sex .. Date of Marital Status: .. B. CONTACT ADDRESS Contact Address which all correspondence with this application should be sent: .. Tel.. C. PARTICULARS OF PARENTS/GUARDIAN Name of Father .. Name of Mother.

2 Name of Guardian (If not sponsored by Parents) .. Address (Parent/Guardian) .. Relationship ..Occupation .. Tel. hereby declare that the information provided by my ward is verified by me and certify to be authentic and genuine. Date .. Affix Passport-size Photograph HERE D. ACADEMIC DETAILS (RESULTS OF SSSCE/WASSCE) Highest academic Qualification obtained (eg. O LEVEL, SSSCE, WASSCE) .. Give details of results if any .. E. WORKING EXPERIENCE State number of years of medical laboratory Experience .. State the name and address of Hospital/ laboratory Facility you are currently working.

3 F. DECLARATION BY APPLICANT I hereby declare that the information provided by me is true and correct, and that I should be denied admission, and/or withdrawn from the school if the information is found to be false. Signature of Applicant .. Date .. G. ENDORSEMENT BY CORROBORATOR (Minister of Religion, Lawyer, Head of Institution or Senior Public Servant) Name and .. I hereby declare that the applicant personally known to me. I have inspected his/her certificate(s) and/or result slip(s) and truly certify that the information provided is accurate and authentic. H. ATTACHMENTS( IF ANY) Certificate(s), Result Slip(s) and any other relevant document Self-addressed envelopes with stamps affixed (2) The completed form, certificate(s), result slip(s) and envelopes should be addressed to: THE REGISTRAR ROYAL ANN COLLEGE OF HEALTH P.

4 O. BOX KS 6253 KUMASI TEL: 020-0597274/050-1391324/020-9146175/024- 7151874