ROYAL ANN COLLEGE OF HEALTH - racoh.edu.gh

1 ROYAL ANN COLLEGE OF HEALTH ATWIMA MANHYIA P. O. Box KS 6253, Kumasi WEBSITE: ADMISSION APPLICATION FORM diploma IN medical laboratory TECHNOLOGY 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 .. 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) TITLE OF SUBJECTS 1st Sitting 2nd Sitting 3rd Sitting 4th Sitting Core English Mathematics Integrated Science Social Studies Elective Aggregate: E.

2 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I hereby declare that the information provided by me is true and correct, and that I should be denied admission, and/or withdrawn from the school if the information is found to be false.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 .. F. 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. Official Stamp: .. G. ATTACHMENTS 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. O. BOX KS 6253 KUMASI TEL: 020-0597274/050-1391324/020-9146175/024- 7151874