2024 Application Form For Diploma in Nursing PSM

DIPLOMA IN NURSING PROGRAMME
APPLICATION FORM
Address: Contacts
Private bag Tel: 52500111 / 22360011
Morija 190 Website: www.scottcon.ac.ls
Lesotho Email: info@scottcon.ac.ls
DEADLINE FOR SUBMISSION OF FILLED IN APPLICATION FORMS:

22ND MARCH 2024 AT 11:00AM
Note: Please fill in the application form in block letters
Application for Admission to Study in 2024
IMPORTANT: Read carefully before completing this form. This application will
not be processed unless accompanied by the required documents and be
signed.
Whenever applicable, use “X” to mark the relevant block.
Non-refundable Application fee: Local applicants: M250.00 International

applicants: M350.00 payable at the bank. Banking details are as follows:
PLEASE NOTE THAT THE APPLICATION FEE IS INCLUSIVE OF BANK
CHARGES.
FOR OFFICE USE
BANK: STANDARD LESOTHO BANK ONLY
BRANCH: TOWER BRANCH Application No.
ACCOUNT NUMBER: 9080000166444 _______________
Date submitted:
ACCOUNT TYPE: CURRENT ACCOUNT
______________
ACCOUNT NAME: SCOTT COLLEGE OF NURSING
Note: Please note your application number given during submission of the
application for interview purposes.
SECTION 1: PREVIOUS APPLICATION
Have you ever been a registered student at Scott College of Nursing?

_________________________
If yes, state the year and student number:

Year: _____________________ Student No.: ____________________
SECTION 2: PERSONAL DETAILS
Surname: _______________________________________________________
Names: __________________________________________________________
Maiden name: ____________________________________________________
Date of Birth: ____________________________
Gender: ________________________________
Title (Mr., Mrs., Miss, Ms., other): _________________
Citizenship: ______________________________________________________
Home Language: __________________________________________________
Country of Permanent Residence: _____________________________________
ID Number: _______________________________________________________
Religion: _________________________________________________________
Denomination: ____________________________________________________
Correspondence address:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Contact Numbers: ________________ ________________________
Marital Status:
Married
Single
Widowed
Divorced
Separated
Number of children, if any: __________________________
1
Present Activity:
Student
Employed
Other (specify)
____________________________________
If employed state, the position:

________________________________________
SECTION 3: HEALTH STATUS
Fair
Good
Do you have any chronic illness (es)? _____________
Give details (if yes)

________________________________________________________________
________________________________________________________________
________________________________________________________________
State food that you are allergic to:

________________________________________________________________
________________________________________________________________
2
SECTION 4: HIGH SCHOOL EXAMINATION DETAILS
Examination:
COSC
LGCSE
IGCSE
Other
If other, specify: ___________________________________________________
Details of School where you completed your final year of high School
Name:
Town:
Country:
Year of
completion:
SUBJECTS PASSED: Please fill in all the subjects passed, and the results
obtained.
SUBJECTS SYMBOLS OFFICE USE ONLY
1.
2.
3.
4.
5.
6.
7.
8.
9.
Note: Foreign high school examination results should be evaluated by the

Examination Council of Lesotho (ECoL) before submitting the application
form.
3
SECTION 5: RECOGNITION OF PRIOR LEARNING
Do you have Certificate in Nursing Assistant qualification? ________________
If yes, give the following details:
Institution where qualification was obtained: _____________________________
Year of completion: _________________________
Years of service as a Nursing Assistant: ________________________________
SECTION 6: ADDITIONAL INFORMATION
Next of kin:
Surname: ________________________________________________________
Names: __________________________________________________________
Title (Mr., Mrs., Miss, Ms., others): _________________
Residential address:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Occupation: ______________________________________________________
Work Tel. No.: ________________________
Home Tel. No.: ________________________
Cell No.: _____________________________
Dialing code: __________________________
Relationship: Tick the relevant next of kin

Father
Mother
Guardian
Spouse
Other (specify)
4
SECTION 7: ENTRY REQUIREMENTS
7.1. The following must be obtained at COSC level:

1. A minimum pass of seven (7) in English Language
2. A minimum pass of seven (7) in Mathematics
3. A minimum of six (6) in Physics / Chemistry / Combined Science with a
pass in Biology or a minimum of six (6) in Biology with pass in Physics /
Chemistry / Combined Science
4. A minimum of six (6) in any other three subjects excluding the above
OR
7.2. The following must be obtained at LGCSE/IGCSE level:

1. Minimum pass of D in English Language
2. Minimum pass of D in Mathematics
3. A minimum of C in Physics / Chemistry / Combined Science with a pass
in Biology or a minimum of C in Biology with pass in Physics / Chemistry /
Combined Science
4. Minimum pass of C in any other three subjects excluding the above
OR
7.3. Certificate in Nursing Assistant with minimum of 2 years working

experience
SECTION 8: SUPPORTING DOCUMENTS TO BE SUBMITTED

1. Filled and signed application form
2. Certified copies of educational certificates or symbols
3. Certified copy of ID
4. Application fee deposit slip
5. Two reference letters (one from your previous school or previous / current
employer if a Nursing Assistant and the other from your church)
Declaration and Undertaking
I, ___________________________________________ the undersigned

applicant, declare that the information provided above is true and accurate to the
best of my knowledge and agree to abide by Scott College of Nursing rules and
regulations, to pay in full all fees and other charges due and payable in terms of
the relevant applicable annual scheduled fees if admitted to study.
__________________________ ______________________________
Date Signature of Applicant
NOTE: Filling in this application form does not guarantee admission

2024 Application Form For Diploma in Nursing PSM

Uploaded by

Copyright:

Available Formats

2024 Application Form For Diploma in Nursing PSM

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2024 Application Form For Diploma in Nursing PSM

Uploaded by

Copyright:

Available Formats

DIPLOMA IN NURSING PROGRAMME

DEADLINE FOR SUBMISSION OF FILLED IN APPLICATION FORMS:

Note: Please fill in the application form in block letters

Application for Admission to Study in 2024

Whenever applicable, use “X” to mark the relevant block.

Non-refundable Application fee: Local applicants: M250.00 International

Have you ever been a registered student at Scott College of Nursing?

If yes, state the year and student number:

SECTION 2: PERSONAL DETAILS

Contact Numbers: ________________ ________________________

Number of children, if any: __________________________

If employed state, the position:

SECTION 3: HEALTH STATUS

Do you have any chronic illness (es)? _____________

Give details (if yes)

State food that you are allergic to:

If other, specify: ___________________________________________________

SUBJECTS SYMBOLS OFFICE USE ONLY

Note: Foreign high school examination results should be evaluated by the

Do you have Certificate in Nursing Assistant qualification? ________________

If yes, give the following details:

Institution where qualification was obtained: _____________________________

Year of completion: _________________________

Years of service as a Nursing Assistant: ________________________________

SECTION 6: ADDITIONAL INFORMATION

Relationship: Tick the relevant next of kin

7.1. The following must be obtained at COSC level:

7.2. The following must be obtained at LGCSE/IGCSE level:

7.3. Certificate in Nursing Assistant with minimum of 2 years working

SECTION 8: SUPPORTING DOCUMENTS TO BE SUBMITTED

Declaration and Undertaking

I, ___________________________________________ the undersigned

You might also like

Contact Numbers: ________