APPLICATION FORM FOR HND

1 PERSONAL DETAILS / INFORMATION PERSONNEL

Gender / Sexe
MALE

Surname (family Name) / Nom

NKWA

First (given) Name / Prenom

NKWA KOTAP MICHELLE MANOELA

Date Of Birth / Date De Naissance

2006-04-26

Place Of Birth / Lieu De Naissance

BABADJOU

Region / Region
WEST

Division / Department D'origine

BAMBOUTOS

Residence / Residence
VILLAGE

Telephone Number / Numero De Telephone

678164842

Email / Address Electronique

MICHELLEMANOELLANKWAKOTAP@GMAIL.COM

2 COURSE ENVISAGED / FILIERE (OPTION)

First Choice / Premier Choix
HND NUTRITION & DIETETICS

Second Choice / Deuxieme Choix

HND MEDICAL LABORATORY SCIENCE

3 LANGUAGE PROFICIENCY / MAITRISE DES LANGUES

1st language / 1er langue 2nd language / 2eme langue

Spoken / Parle English Spoken / Parle French

Written / Ecrit English Written / Ecrit French

4 MEDICAL HISTORY / ANTECEDENTS MEDICALE

Any Known Health Problem? / Avez-Vous Un Problem De Sante?
No

If Yes, Mention? / Si Qui, Lequel?

Any Known Health Allergy? / Avez-Vous Un Problem De Allergies?

No

If Yes, Mention? / Si Qui, Lequel?

Any Disabilities? / Avez-Vous Un Handicap?

No

If Yes, Mention? / Si Qui, Lequel?

5 ENTRY QUALIFICATION / DIPLOME OU CERTIFICAT D'ENTREE

Awaiting Results? / En Attente De Resultats?
No

8 FINANCIAL OBLIGATION / OBLIGATIONS FINANCIERES

Who Is Responsible For Your Fee (relationship) ? / Qui Est Charge De Payer Votre Pension ?
Father

Name ? / Nom ?
NGWA BORDELAIRE

Residence
Village

Tel
676713720

Occupation / Profession
Trader

9 DECLARATION BY CANDIDATE / DECLARATION PAR LE

CANDIDAT

I confirm that the information given on this form is true and complete. No
information requested or other important information has been ommitted or
altered. I undertake to respect the rules and regulations of the institution. I
accept that if I do not fully comply with the requirments, the institution shall
have the right to cancel my application and more so terminate my
admission; and I shall have no claims against ST LOUIS UNIVERSITY
INSTITUTE, DOUALA. .

Je, confirme que les informations renseignées dans ce formulaire sont

vraies et complete. Aucune information importante n’a été omis ou alterer.
Je m’engage à respecter les règles et les règlements de l’institut. J’accepte
que si je ne me conforme pas pas entierement aux exigences, l’Institut aura
le droit d’annuler ma candidature et e mettre fin à mon admission; et je
n’aurai aucune reclamation contre L’INSTITUT UNIERSITAIRE ST LOUIS,
DOUALA..

10 DECLARATION BY PARENT, GUARDIAN / DECLARATION DU

PARENT, TUTEUR

I, the undersigned NGWA BORDELAIRE do solemnly declare that I would

be responsible for any financial need of the applicant and promise to pay
promptly ail fees and any other finance demanded by the institution: for
proper training.

Je, soussigné NGWA BORDELAIRE declare solonellemement que je

serais responsible des besoins financiers du démandeur at je promet de
payer a temps tous les frais et autres financement exigés par l’Institut pour
une formation appropriée.

_________________
Signature
Wednesday 20-09-2023
Date

BONAMOUSSADI
FACULTY: FACULTY OF ENGINEERING & TECHNOLOGY .
BANK: AZIRE COPOPERATIVE CREDIT UNION .
ACCOUNT NAME/ NOM DE COMPTE: ST LOUIS HIGHER INSTITUTE OF MEDICAL
STUDIES
ACCOUNT NO/ DE COMPTE: PN08_1253

FACULTY: FACULTY OF HEALTH & BIOMEDICAL SCIENCES .

BANK: AZIRE COPOPERATIVE CREDIT UNION .
ACCOUNT NAME/ NOM DE COMPTE: ST LOUIS HIGHER INSTITUTE OF MEDICAL
STUDIES
ACCOUNT NO/ DE COMPTE: PN08_1253

FACULTY: ALL FACULTIES .

BANK: PAY BY MTN MOBILE MONEY .
ACCOUNT NAME/ NOM DE COMPTE: FEES PAYMENTS , TRANSCRIPTS APPLICATION
PAYMENT
ACCOUNT NO/ DE COMPTE: TRANZAK

FACULTY: ALL FACULTIES .

BANK: PAY BY ORANGE MONEY .
ACCOUNT NAME/ NOM DE COMPTE: FEES PAYMENTS , TRANSCRIPTS APPLICATION
PAYMENT
ACCOUNT NO/ DE COMPTE: TRANZAK

Request a receipt for every amount paid at the bank and present it in school alongside a
photocopy for cross checking. Yourapplication shan only be processed upon payment of the
Application fee. Toujours demander un reçu pour chaque montant paye a la banque et le
presenter a l'ecoomat de l'institute avec deux (02) photocopies pour verification. Votre demande
ne sera traitée qu'apres paiement (a la banque) des frais de dossier Admission Criteria
/Criteres

We admit science students With 2-25 points in any of the departments of the St Louis of Medical
Studies and the Institute of Engineering and Technology. study. Art students are usually
admitted With 4-25 points and can onlv study Nursing or Midwifery.

We shall exceptionally admit arts students With 2 points especially earned in the social sciences
like Economics and Geography. This admission is conditional and they must prove their
worth and stay along With the rest of the class otherwise they will be discontinued at the end of
the year.

Les candidats avec un BACC scientifique peuvent être admis dans toutes les filières de
l'Institut Médicales et de Technologie. Nous admettons ceux qui ont le BACC GI, G3 et A,
uniquement dans les programmes suivants ; Soins Infirmier, Sage-Femme ou Agriculture.
Cette admission est conditionnelle et ces candidats devront prouver leur valeur en
avançant avec le reste de la promotion sinon a la fin de l'année ils seront conseiller de se
retirer.