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    Application Form MSPH

    Uploaded by

    Saleem Chishti

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form MSPH

    Uploaded by

    Saleem Chishti
    3 views6 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

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    3 views6 pages

    Application Form MSPH

    Uploaded by

    Saleem Chishti

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 6

    AL-SHIFA SCHOOL OF PUBLIC HEALTH

    PAKISTAN INSTITUTE OF OPHTHALMOLOGY


    AL-SHIFA TRUST, RAWALPINDI

    Form No. Photograph

    APPLICATION FORM

    MSPH Programme

    Al-Shifa School of Public Health

    Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi

    Tel: 051-5487820-24; http://sofph.alshifaeye.org/

    SEMESTER SPRING/FALL 20____

    1
    1. SECTION 1: PERSONAL INFORMATION

    FULL NAME: MS./MRS./MR./DR.

    (As on Matriculation certificate)

    FATHER’S NAME:

    SEX: MALE FEMALE DATE OF BIRTH: / /

    (As on Matriculation certificate)

    National Identity Card No.

    (Passport No for foreign Students)

    DOMICILE (PROVINCE): NATIONALITY:

    PERMANENT ADDRESS:

    PHONE NO: MOBILE:

    (with area code)

    POSTAL ADDRESS:

    PHONE NO: MOBILE:

    (with area code)

    OFFICE NO: FAX NO:

    (with area code) (with area code)

    EMAIL:

    2
    2. SECTION 2: ADDITIONAL SKILLS

    Please note that the following questions are NOT part of our selection criteria for the first phase of
    short-listing; however please note that the Al-Shifa School of Public Health, PIO will be interested
    to know about these skills in the interviews after the first phase is complete.

    ENGLISH LANGUAGE SKILLS

    How do you rate your English language skills?

    POOR FAIR GOOD EXCELLENT

    SPEAKING

    WRITING

    How do you rate your computer skills?

    POOR FAIR GOOD EXCELLENT

    MICROSOFT
    WORD
    MICROSOFT
    POWER
    POINT
    MICROSOFT
    EXCEL
    SPSS

    ANY OTHER SOFTWARE (SPECIFY)

    3
    3. SECTION 3: QUALIFICATIONS AND EXPERIENCE

    ACADEMIC QUALIFICATIONS

    List all the colleges and universities attended in reverse chronological order. Begin with the most recent
    university.

    NAME OF PLACE, DATES ATTENDED DEGREE PASSING MARKS TOTAL


    INSTITUTION COUNTRY FROM TO NAME YEAR OBTAINED MARKS

    PROFESSIONAL EXPERIENCE

    Please describe briefly the nature of your work and responsibilities (for last five years). List most recent
    employment first.

    NAME OF MAJOR RESPONSIBILITIES POSITION DATES EMPLOYED


    INSTITUTION AND ACTIVITIES FROM TO

    TOTAL EXPERIENCE IN Y EAR S MONTHS

    Please list any research publications

    4
    4. SECTION 4: STATEMENT OF PURPOSE

    Outline your reasons for your interest in the Post-graduate degree course (MSPH), and your plans for
    the future. Describe the kind of training you expect to undertake, and explain how your study plan fits in
    with your previous training and your future goals. Mention how relevant experiences, such as research
    in the field of public health, will aid you in achieving your study objectives. Please do not exceed the
    space provided below.

    5
    SECTION 5: SIGNATURE FORM

    If you are offered admission to the MSPH Course, how do you plan to pay for it?

    EMPLOYER: SELF: OTHER (SPECIFY):

    PAYMENT SCHEDULE

    LUMP SUM SEMESTER WISE

    I affirm that the information on this application form and any additional material that I submit is
    complete and accurate to the best of my knowledge. I understand that furnishing false or incomplete
    information may be cause for denial of admission, cancellation of registration, or revocation of degree.

    APPLICANT’S SIGNATURE: DATE:

    NOTE: All applicants are required to send:

    1. Complete filled application form handwritten or typed.

    2. Two complete ATTESTED/VERIFIED sets of all documents (Last Degrees must be verified,
    Domicile, ID Card, 2 passport size photos)

    3. Application processing fee of Rs. 2,000/- (non- refundable) in the form of pay order or bank
    draft made to “Al-Shifa Trust Eye Hospital, Rawalpindi”

    4. Can be submitted in person or through TCS/Courier services at the address given below:

    MSPH Admission,
    Al-Shifa School of Public Health,
    Pakistan Institute of Ophthalmology,
    Al Shifa Trust Eye Hospital,
    Jhelum Road, Rawalpindi.

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