MUHAS/PG.F1 MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES DIRECTORATE OF POSTGRADUATE STUDIES

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1 MUHAS/PG.F1 MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES DIRECTORATE OF POSTGRADUATE STUDIES APPLICATION FOR ADMISSION TO MASTER BY COURSEWORK DEGREE PROGRAMMES (PRINT OR USE BLOCK LETTERS) Summary of official decision (FOR OFFICIAL USE ONLY): APPLICATION FOR ADMISSION TO MASTER PROGRAMME FOR THE YEAR... STUDENT S PARTICULARS: 1. Surname:. 2. First Name:.. 3. Middle Names: NOTE: The name in which you will be registered will be that which appears on your firstdegree certificate and/or internship and/or registration certificate as a Medical/Dental/ Pharmacy/Nursing practitioner.. Date of Birth: 5. Place of Birth: 6. District:.. 7. Married or Single:. 8. Sex (M or F): Citizenship:... 1

2 10. Country of Residence: Address to which information should be sent if applicant is successful. Postal.. .Tel... NOTE: Change of this address must be communicated to the ADMISSION OFFICE immediately. ACADEMIC QUALIFICATION & PROFESSIONAL EXPERIENCE 12. Pre- University level: School/College Year Completed Certificate Obtained Examination Number University level: Degree Class Name of Years Attended Achieved of Degree (s) University From To Undergraduate Qualification to Support this Application is:... degree for which Certificate is attached: NOTE: Certified copies of transcripts must be enclosed. 1. Internship: Hospital/Institute... Address

3 15. Professional training: 16. Work Experience Name of Institution Award Given Year of Completion Post Held Employer When (Month/Year) ACADEMIC REFEREES: 17. Provide names and Address of two most suitable academic referees: EMPLOYER: i. Name... Address ii. Name... Address 18. Name of Employer:... Address: If the applicant gains admission, will you release her/him for studies? (Tick) YES NO Employer s Signature: Date:... SPONSORSHIP: 20. Commitment of Financial Sponsor(s) for the full course: Name:.. Address:. Sponsor s Signature:... Date:... 3

4 21. CHOICE OF PROGRAMME DEGREE PROGRAMME DURATION IN SEMESTERS 1. SCHOOL OF MEDICINE Master of Science (MSc.) Anatomy Biochemistry Cardiology Urology Clinical Pharmacology Haematology & Blood Transfusion Neurosurgery Neurology Nephrology Respiratory Medicine Master of Medicine (MMed)* Anaesthesiology 6 Anatomical Pathology 6 Haematology and Blood 6 Transfusion Internal Medicine 6 Microbiology and 6 Immunology Obstetrics and Gynaecology 6 Ophthalmology 6 Orthopaedics and Trauma 6 Ortorhinolaryingology 6 Paediatrics and Child Health 6 Psychiatry 6 Radiology 6 Surgery 6 Urology 6 2. SCHOOL OF DENTISTRY Oral Pathology 6 Master of Dentistry (MDent)* Oral Surgery 6 Restorative Dentistry 6 Community and Preventive 6 Dentistry 3. SCHOOL OF PUBLIC HEALTH AND SOCIAL SCIENCES Master of Arts (MA) Health Policy and Management Master of Bioethics (MBE) Bioethics CHOICE OF SPECIALISATION OR SUPER- SPECIALISATION

5 Master of Medicine (MMed) Community Health 6 Master of Public Health Public Health 2 (MPH)-Regular track Master of Public Health Public Health (MPH)- Executive track Master of Public Health Public Health (MPH)- Distance Learning Master of Science (MSc) Tropical Disease Control Applied Epidemiology Epidemiology and Laboratory Management Parasitology and Entomology Health Information Management. SCHOOL OF PHARMACY Master of Science (MSc) Pharmaceutical Management Master of Pharmacy Clinical Pharmacy (MPharm)* Industrial Pharmacy Hospital and Community Pharmacy Medicinal Chemistry Pharmaceutical Microbiology Pharmacognosy Quality Control and Quality Assurance 5. SCHOOL OF NURSING Master of Science (MSc) Critical Care and Trauma Mental Health 6. INSTITUTE OF TRADITIONAL MEDICINE Master of Science (MSc) Traditional Medicines Development *For MMed, MDent and M. Pharm degree programmes, please indicate up to THREE choices. STATEMENT BY APPLICANT: I have acquainted myself with entrance qualifications for admission to Muhimbili University of Health and Allied Sciences and with the courses available and certify that to the best of my knowledge the information given above is correct. Signature of Applicant:... Date:... 5

6 NOTE: Your application forms will not be processed if you have not enclosed Bank Pay-in Slip of TShs. 50,000/= for Tanzanians and US $ 50 for non Tanzanians (Master applicants) and Tsh 70,000/= for Tanzanians and 70 USD for non-tanzanians (PhD and postdoc applicants). The Bank payments should be made into the following bank account 1. For Local transactions: National Microfinance Bank (NMB), Muhimbili Branch MUHAS Bank Account Number SWIFT CODE: NMIBTZTZ 2. For Foreign transactions: NBC Samora Branch Bank Account Number SWIFT NO. SAMORA BRANCH NLCBTZTXXXXX Enclose all certificates, all transcripts and curriculum vitae. FOR OFFICIAL USE ONLY: ( as appropriate) Certificates (CSEE..., ACSEE...,Diploma...,Undergraduate degree..., Master degree..., PhD...) Transcripts (Undergraduate degree..., Master degree...) Internship Curriculum Vitae Application Fees Referee form MUHAS/ PG.F2 6