Application Form 2010 English
Application Form 2010 English
Application Form 2010 English
MINISTRY OF HEALTH
PORT VILA
VANUATU
APPLICATION FORM
Requirements:
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
Written Spoken
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.
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
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