Emergency Medical Technician (EMT)
Academic Application Form

Fill out the form carefully for registration

Please note that this applications attaracts a non-refendable fee of Ksh.500

Student Details

Valid first name is required.
Valid last name is required.
Gender is required.
Please enter a valid date of birth.
Please enter a valid email address for shipping updates.
Please Attach a passpport size photo
Your Parent ID/Passport Number is required.
Please Attach a certificate
Your Phone Number is required.
Your Parent Phone Number is required.
Please enter a valid email address for shipping updates.
Please enter your Postal address.
Please select a valid county.
Please provide a valid Town.

Course Details

Please select a valid course.
Please provide a intake month.

Secondary School Results

Please select valid Grade
Please select valid Grade
Please Attach a certificate

Additional qualifications and experience


Application Payment Details

Payment via Bank

Bank Reference is required.
Please enter a valid date of Payment.

Payment via Mpesa

Bank Reference is required.
Please enter a valid date of Payment.

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