MBEYA POLYTECHNIC COLLEGE-TUKUYU CAMPUS

P.O BOX 479, TUKUYU. Mob.: 0764-774 929 / 0754-324 030

Website: www.mbeyacollege.ac.tz
Email: mpc.tukuyucampus@gmail.com

APPLICATION FORM FOR ADMISSION

(To be filled in duplicate and send it to the College, by hand, email or Post Office)

PART I

PROGRARMS OFFERED
(According to your educational qualifications, choose only one program by ticking)

NACTE PROGRAM VETA PROGRAM

COURSE (NTA) ENTRY TICK COURSE (NVA) ENTRY TICK
QUALIFICATIONS QUALIFICATIO
NS
Basic Technician At least four passes (D), Horticulture and Holder of
Certificate in three must be science Field Crops Certificate of
Agriculture and subjects; OR holders of Production Secondary
Natural Resources National Vocational (NVA I) Education
Management Award (NVA) level III. Examination
(CSEE) with two
passes.
Technician one Principle pass and Horticulture and Holder of
Certificate in one subsidiary pass in Field Crops Certificate of
Agriculture and science subjects Production Secondary
Natural Resources (NVA II) Education
Management Examination
(CSEE) with two
passes. And
possession of NVA
level I
Ordinary Diploma Holder of technician Horticulture and Holder of
in Agriculture and certificate (NTA Field Crops Certificate of
Natural Resources level 5)in related field Production Secondary
Management (NVA III) Education
Examination
(CSEE) with two
passes. And
possession of NVA
level II

MBEYA POLYTECHNIC COLLEGE-TUKUYU

l CAMPUS 2019 - 2020
 PART II

A. PERSONAL PARTICULARS

1. Name of Applicant:

2. Gender: a) Male b) Female

3. Date of Birth: ______/________/ _____

4. Marital Status: a) Single: b) Married:

c) Divorced: d) Widow:

5. Contact Information: a) Mobile b) Email:

c) Permanent Address P.O .Box.

D) Region e) District

6. Emergency Contact Information: a) Name of Contact Person:

b) Relationship:

c) Mobile: d) Email:

e) Permanent Address:
P.O Box.

B. PARENT’S / GUARDIAN’S PARTICULARS

1. Name of Parent / Guardian:

2. Contact Information: a) Mobile: b) Email:

c) Permanent Address:

C. ACADEMIC RECORD

1. Primary school

a) Name of School

b) Year Completed

MBEYA POLYTECHNIC COLLEGE-TUKUYU CAMPUS 2019 - 2020

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 2. Certificate of Secondary Education Examination

I) First seat

a) Name of School / Institution:

b) Year Completed: c) Index no.

S GH
SUBJECT MATHS BIO CHEM PHY GEO AGRIH HIST ENGL KISW
HIS CIVS E/LIT
S E
GG
GRADE
II) Second seat ( PC)
a) Name of School / Institution:

b) Year Completed: c) Index no.

S GH
SUBJECT MATHS BIO CHEM PHY GEO AGRIH HIST ENGL KISW
HIS CIVS E/LIT
S E

GG GRADE

3. Advanced Certificate of Secondary Education Examination (Science subjects only)

I) First seat

a) Name of School / Institution:

b) Index No:

c) Year: Completed:

SUBJECTS MATH PHY CHEM BIO GEO AGRI NUTRION

GRADE

II) Second seat (P C)

a) Name of School / Institution:

b) Index No:

c) Year: Completed:

SUBJECTS MATH PHY CHEM BIO GEO AGRI NUTRION

GRADE

MBEYA POLYTECHNIC COLLEGE-TUKUYU CAMPUS 2019 - 2020

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 4. Vocational Education & Training Authority Examination
a) Name of Institution:

b) Year taken:

c) Pass / Fail:

D. Declaration
I______________________________ declare that all information given in this form is correct to the best of my knowledge
Signature of applicant ___________________________Date___/____/____________

NoteThe information given in this form will be used for Admission purposes only. Note: Disclosure of details or provision of false
information to any of the sections in this form, if discovered, shall render your registration cancelled and legal actions taken.

E. FOR OFFICIAL USE ONLY

Application form has been received by the Admission officer, MPC-TUKUYU CAMPUS

Name of Officer ________________________________

Signature _______________________ Date ______________________

Decision by college registration committee _____________________________

Decision by College’s Principal____________________________________

Attach Tsh. 10,000/= receipt for application fee payable to Mbeya Polytechnic College. The fee is non-
refundable and may not be transferable.

Bank Account Particulars M-Pesa Account particulars

CRDB BANK 0764-774 929
Mwanjelwa branch,
Mbeya Polytechnic College
A/C No.0152265309600

“MBEYA POLYTECHNIC COLLEGE- TO LEARN IS TO CHANGE”

MBEYA POLYTECHNIC COLLEGE-TUKUYU CAMPUS 2019 - 2020

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