1. health and fitness
2. disease
3. thyroid disease

THE UNITED REPUBLIC OF TANZANIA
Local Government Training InstituteDodoma
PASSPORT
SIZE
P.O. Box 1125 DODOMA
Tel: 0658-450501, 0765-779157, 0658-450503
Fax: 026 – 2961100
Website: www.lgti.ac.tz
E-mail: [email protected]
APPLICATION FORM FOR ADMISSION
Application for admission to Certificate and Diploma courses tenable at the Local Government
Training Institute (LGTI) -DODOMA
NOTE:
(a)
Applicant must affix a passport size photograph. Application form without a photograph
will not be considered.
(b)
This form when completed must reach the Registrar by 30th May 2015. Forms received
after this date will not be considered.
(c)
Each applicant must pay a non- refundable fee of Tshs 30,000/= for the form.
Application forms will not be processed without receipt of application fee. The payment
should be made through the Institute’s NMB Account Na.50501100209 LOCAL
GOVERNMENT TRAINING INSTITUTE - FEE ACCOUNT. Bank’s Pay In- Slip
should be submitted together with this application form.
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I
APPLICANT`S PARTICULARS
Please use capital letters. The names entered on this form must be the same as those
appearing on relevant certificates i.e. C.S.E.E, A.C.S.E.E. or equivalent document.
(Fill your names exactly as they appear in your academic certificates).
1.
First Name……………………………………………………………………..
2.
Middle Name………………………………………………………………….
3.
Surname……………………………………………………………………….
4.
Sex ………………………………………………………………………….
5.
Date of Birth………………………………………………………………..
6.
Place of Birth ………………………………………………………………
7.
Permanent Home Address………………………………………………….
8.
9.
Contact Address ……………………………………………………………..
……………………………………………………………………………
E-mail Address ……………………………………………………………..
10.
Telephone Number………………………………………………………….
11.
Marital Status...………………………………………………………………
12.
Name and Address of Spouse……………………………………………......
…………………………………………………………………… …….
13.
Number of children…………………………………………………………….
14.
Citizenship…………………………………………………………………......
15.
Name and address of Employer/Sponsor
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
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II
EDUCATION BACKGROUND
(a) Certificate of Secondary Education Examination (C.S.E.E ) or Equivalent
(From………………….to…………………Index Number………………….)
SUBJECT
GRADE
Examination Authority ………………………….. …………………….Division…….
Examination Centre/ School. …………………………………………………………
Country ………………………………………………………………………………
(b) Advanced Certificate of Secondary Education Examination (A.C.S.E.E.) or
Equivalent
(From…………………….to……………………Index Number………………)
SUBJECT
GRADE
Examination Authority ………………………….. …………………Division………...
Examination Centre / School. …………………………………………………………
Country ………………………………………………………………………………
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(c) Details of Any Other Qualifications e.g. Diploma, Certificate etc.
INSTITUTE/
COURSE TAKEN FROM
TO
INDEX
INSTITUTION
(YEAR) (YEAR) NUMBER
(d)
AWARD
Employment Record
EMPLOYER
POST HELD
DATE
16. Study Programme at LGTI
(a) Proposed fields of study (Please tick (√) the appropriate field)
i)
Basic Technician Certificate in Local Government Administration
ii) Basic Technician Certificate in Local Government Accounting and
Finance
iii) Basic Technician Certificate in Community Development
iv) Basic Technician Certificate in Human Resource Management
v) Basic Technician Certificate in Procurement and Supply
vi) Basic Technician Certificate in Records, Archives and Information
Management
vii) Ordinary Diploma in Local Government Administration
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viii)
Ordinary Diploma in Local Government Accounting and Finance
ix) Ordinary Diploma in Community Development
x) Ordinary Diploma in Human Resource Management
xi) Ordinary Diploma in Procurement and Supply
viii) Ordinary Diploma in Records, Archives and Information Management
(b) Why do you think this field of study is relevant?
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………
(c) Have you applied to any other Institution /Institute?
YES
NO
If the answer is YES, mention the course(s) applied for and respective
Institution/Institute ……………………………………………………………….
……………………………………………………………………………………
17. Do you have any Physical or Communication Disabilities?
YES
NO
(a) If YES above tick whichever is applicable
Speech / Hearing / Mobility / Vision / Others
(c) Give details of disability……………………………………………………….
…………………………………………………………………………………………
………………………………………………………………………………………..…
…………………………………………………………………
III
GENERAL INFORMATION
1.
Completion of the form
Forms are to be completed in duplicate using BLOCK LETTERS.
One copy should be returned to the Institute through the address given below. The
second copy should be retained by the Employer/Sponsor (if any)
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The Registrar,
Local Government Training Institute (LGTI),
P. O. Box 1125,
DODOMA,
TANZANIA.
2.
IV
Documents to be enclosed
i)
Completely filled in application forms
ii)
Certified copies of your original certificates e.g. Certificates for
Secondary School Education both Form IV and Form VI.
iii)
A certified copy of your academic transcript
iv)
A certified copy of your birth certificate
v)
Two recent passport size photographs
vi)
A copy of any evidence that application fee has been paid
DECLARATION BY THE CANDIDATE
I……………………………………… hereby certify that the information in this
Application form is correct and complete.
Signature of Applicant ……………………………………….
Date…………………………………………………………...
V.
DECLARATION AND CONFIRMATION OF EMPLOYER/SPONSOR
I/We…………………………………….hereby certify that information filled in this
application form is correct, true and complete and that I/We guarantee to sponsor the applicant.
Name and Signature of Employer/Sponsor
…………………………………………………………………………………………….
.............................................................................................................................................
Date……………………………………
NOTE: Fees structure is attached in appendix 1
FEE STRUCTURE AND OTHER CHARGES APPLICABLE 2015/2016
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COST ITEMS
CERTIFICATE
PROGRAMMES
(ALL)
ORDINARY DIPLOMA
PROGRAMMES(ALL)
DIRECT COST PAYABLE TO THE
INSTITUTE
(ONE YEAR)
YEAR 1
YEAR 2
CITIZENS
(TSH.)
(TSH.)
(TSH.)
1 Tuition fee -annually
660,000
760,000
770,000
2 Registration -once
20,000
20,000
-
3 Examination fee- annually
30,000
30,000
30,000
4 Identity card -once
10,000
10,000
-
5 Students' Union -annually
20,000
20,000
20,000
6 Field Supervision - annually
50,000
50,000
50,000
7 Sports and Games - annually
Foundation Courses (Intensive English
8 Course)
20,000
20,000
20,000
10,000
10,000
10,000
9 NACTE subscription
15,000
15,000
15,000
835,000
935,000
915,000
300,000
300,000
300,000
1,135,000
1,235,000
1,215,000
TOTAL FEE
9 Accommodation - annually
TOTAL FEE AND ACCOMODATION
LOCAL GOVERNMENT TRAINING IINSTUTUTE FEE ACCOUNT - NO. 50501100209 NMB
NON CITIZENS
US $
US $
US $
EAC
1,100
1,200
1,200
Others
1,600
2,000
2,100
CITIZENS
(TSH.)
(TSH.)
(TSH.)
Meal allowance
1,785,000
1,785,000
1,785,000
Books and stationery
150,000
150,000
150,000
ITEMS PAYABLE DIRECTLY TO THE STUDENT
- RECOMMENDED
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Scientific Calculator
40,000
40,000
40,000
Field Assigment
280,000
280,000
280,000
Research
-
280,000
280,000
Application Fee
30,000
30,000
30,000
Graduation Fee
30,000
30,000
30,000
2,315,000
2,595,000
2,595,000
3,490,000
3,870,000
3,850,000
US $
US $
US $
5,000
5,000
5,000
NON CITIZENS
Mode of payments
(i)
Registration and identity card are paid only once during first year.
(ii)
Payments can be made in two installments (i.e. semester I and Semester II.) as
Shall be indicated in joining instruction form once you are selected
NOTE:
1) Fees once paid are not refundable
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2) Local Government Training Institute reserves the right to change the rate of fees any
time during the Academic year as deemed necessary without prior notice.
3) Other recommended direct student costs (incurred by sponsors or students) are merely
indicative
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