ONLINE APPLICATION FORM Please enable JavaScript in your browser to complete this form.1. Student Name *FirstMiddleLast2. Form IV Examination Number *3. Date of Birth *12345678910111213141516171819202122232425262728293031JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119404. Email *5. Phone Number *6. Physical Address *7. Mailing Address *8. Gender *MaleFemale9. Marital Status *Single/UnmarriedMarried10. Mother's Name *FirstMiddleLast11. Father's Name *FirstMiddleLast12. Parent/Guardian Phone Number *13. What is your program of interest? *Certificate in MedicineDiploma in Medicine14 (a). Are you a citizen of the Republic of Tanzania? *CitizenNon-Citizen14 (b). If you selected "Non-Citizen" above, please indicate your country of citizenship. Enter "N/A" if this portion does not apply to you. *15 (a). If you do not have citizenship status, please indicate the type of immigration document you possess (you will be required to submit a copy of any such document): *Permanent ResidentResident Permit (Class C)Student VisaOther15 (b). If you selected "Other" above, please specify the type of immigration document you possess. Enter "N/A" if this portion does not apply to you. *16 (a). As a student, do you have any disability (physical or mental impairment that substantially limits your activities) or require any special accommodations? *YesNo16 (b). If you checked "Yes" above, please explain. You may also be required to provide supporting documentation. Enter "N/A" if this portion does not apply to you. *17. List all Primary and Secondary schools attended and the full name of the certificates awarded. Please include the relevant dates of attendance. *18. List all post-secondary institutions you have attended. Please include the relevant dates of attendance. Enter "N/A" if this question does not apply to you. *19. List any special awards, trainings, and qualifications you possess, which are relevant to your application.20. Please write a short paragraph in response to the following question. Why do you wish to attend RAO HTC? *21 (a). How did you hear about RAO HTC? (Check all that apply) *Radio AdvertisementTelevision Commercial/AdvertisementBlog PostSocial Media (Facebook, Twitter, Snapchat, Instagram)Former StudentCurrent StudentRAO Hospital EmployeeRecruitment EventScholarship SearchRAO Rewards Program21 (b). Please provide information on how you heard about our programs. *Application for Admission to RAO Health Training CentreMessageSubmit