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The State University of Zanzibar - SUZA Size

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School of Health and Medical Sciences

Hostel Application Form for Academic Year 2023/2024
1.0 Student’s Personal Information
1.1 Name …………………………………………1.2 Gender: ………………....
1.3 Nationality: …………………………………1.4 Date of Birth: ……………
1.5 Place of Birth …………………1.6 District: …………1.7 Region: ………
1.8 Physical Address: …………..............................................................
1.9 Shehia …………............................1.10 House Number: ………........
1.11Telephone Number: ………………………………................................
1.12 Email: ………………………………....................................................
1.13 Passport Number/ZAN ID, TANZ ID: ………………………................
1.14 Disability if any: …………………....................................................
1.15 Medical illness if any: ……………………………………………………...
2.0 Admission Information
2.1 Department Name: …………………………………………………………
2.2 Programme: …………………………………………................................
2.3 Year of Study: …………………………...2.4 Semester: ........................
2.5 Registration Number: ………………………………………………………..
3.0 Declaration
I do hereby declare that, if admitted to the SHMS hostel, I shall obey all the rules and
regulations of the hostel to help the authority in maintaining good conduct and set
myself a good example and leave the Hostel on the direction of the School Warden.

3.1 Date: ………………… 3.2 Signature of the Student: …………………

4.0 For Official Use Only

4.1 Application Status: Accepted ( ) Not Accepted ( )
4.2 Official Signature’s: ....................... 4.3 Date: ……………
Note: The following are School Hostel Fee Per Semester for the Academic Year
2023/2024. Tick the One You Prefer.
Male Hostel Price Tick Female Hostel Price Tick
Hostel E 100,000/= Hostel A 125,000/=
Hostel F 125,000/= Hostel B 125,000/=
Hostel C 125,000/=
Hostel D 100,000/=

*Hostel payment paid through control number acquired from the School Accountant
Office