Application Form 2010 English

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APPLICATION FORM - DIPLOMA IN GENERAL NURSE TRAINING - 2010

VANUATU COLLEGE OF NURSING EDUCATION (VCNE)


INSTITUT DE FORMATION EN SOINS INFIRMIERS DU
VANUATU (IFSIVU)

MINISTRY OF HEALTH
PORT VILA
VANUATU

APPLICATION FORM

DIPLOMA IN GENERAL NURSE TRAINING

Commencement date: January 2011


APPLICATION FORM - DIPLOMA IN GENERAL NURSE TRAINING - 2010

CRITERIA FOR ENROLLMENT


A. The Program is open to both female and male

Requirements:

1. Must be a citizen of Vanuatu


2. Must have passed year 12 with good pass marks of 1-4 (PSSC exam) in English, French, Mathematics and
the Sciences.
3. Must be age between 18 –30 years
4. Must be in good physical and mental health
5. Must have genuine interest and motivation to serve community
6. Must not have previous criminal record

B. Personal Details

1. First name:_______________________________________
2. Family name: _____________________________________
3. Date of Birth: _____/_______/_______
Day / month / year
(Please attach photocopy of birth certificate)
4. Gender: Male / Female
5. Marital Status: Married / Single
6. Island of Origin: ___________________________________
7. Place of Residence: ________________________________
8. Mailing Address:
___________________________________________________________________________________________
___________________________________________________________________________________________
9. Telephone number: ____________________
This will need to be a reliable number, where you can be contacted at all times.

C. Educational Background

Names of Schools Attended From To Qualifications Gained


APPLICATION FORM - DIPLOMA IN GENERAL NURSE TRAINING - 2010

D. Language Ability (Please tick appropriate box)

Written Spoken

Languages Good Basic None Good Basic None

English

French
Other languages (vernacular,
Spanish, Chinese etc

E. Background work experiences: (state and explain the type of job you had been employed in (before or currently):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
F. Please give details of why you chose to do the Diploma of General Nurse course in the space provided below.
(use an attached page if more space is needed)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
G. Course Fees

You will be required to pay tuition fees of 20,000 vatu per semester.
Course fees must be paid at the beginning of each semester. The diploma course consists of 6 semesters.

H. Please, send with this form, a copy of the following items:

 Year 12 Certificate
 School Academic Reports, plus any other certificates you have
 Three (3) Character References (preferably one from the Principal of your last school, one from your last
science teacher, one from a respectable member of community (e.g. Chief, pastor, BUT not from a family
member.
 Medical (fitness) Report (less than 3 months old)
 Three passport size photos
 A copy of your birth certificate

I. Application must be forwarded to Vanuatu College of Nursing Education from 27th July 2010
J. Application postage date closes on Wednesday 8th September 2010

K. Address your application to:


To: The Principal Nurse Educator
Vanuatu College of Nursing Education
Post Office Box 1221, Port Vila

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