INTERNATIONAL PARAMEDICAL / NURSING INSTITUTE- MAYA APPLICATION FOR THE DIPLOMA /CERTIFICATE COURSES FOR THE ACADEMIC YEAR 2020/2021

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P.O. BOX 72128, KAMPALA.
MOTTO: Health: Our Priority
TEL: +256392-001-503, +256775-534-797, +256703-373-697, +1804-2928771
Email: info.ipim@gmail.com
www.paramedicalinstitute.org
The name and photo associated with your Google Account will be recorded when you upload files and submit this form.

NB. To be fully admitted to IPM, you should come to the College and Present your academic documents to Academic Register

Surname *

First Name

Phone Number *

Date of Birth *

YYYY

Gender *

Female

Male

Address

Select Courses

Select two courses you are Interested In

Diploma in Clinical Medicine

Diploma in Public Health Dentistry

Diploma in Medical Laboratory

Diploma in Pharmacy

Diploma in Medical Records Management

Certificate in Pharmacy

Certificate in Medical Laboratory

Certificate in Medical Records Management

Certificate in Nursing and Midwifery

Academic Performance

O-Level Performance (Enter All Subjects e.g Eng(D1), Math(D2), Chemistry(C3)) *

O-Level Index Number *

A-Level Performance (Enter All Subjects In the Combination e,g Biology(A), Chemistry (B), Mathematics (A)

A-Level Index Number

Any Other Medical Related Academic Certificate

Sponsorship

Select Sponsorship Option *

Self Sponsorship

NGO

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