New Student Online Application Form - Anglican Medical Training College- Maseno

University Enrollment Form (#4)

Required Documents/Attachments

Please note that application fee payments must be made during the application via M-Pesa. All courses, apart from Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS), have an application fee of KES 1,000.
Failure to complete the application fee payment will result in an incomplete application, implying that you have not applied for the course.
A payment form will appear after submitting your application details by clicking ‘Proceed To Payment,’ with details on how to complete the payment.

Faculty/Course Selection

Select The Faculty/Course You Want To Join

First Name

Last Name

Phone

Date of Birth

Gender

Male

Female

Others

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Required Documents/Attachments

Applicant’s Photo

Choose File

National ID /Passport

Choose File

High School Certificate

Choose File

Good Conduct. Or a copy of your good conduct application invoice or receipt if your application is in its processing stage.

Choose File

Background Information:

Enrollment Status

Full Time

Part Time

High School Name

High School Address*

Address Line 1

Address Line 2

City

State

Zip Code

Country

KCSE Grade

Medical Allergies

Parent/Guardian Information:

Parent/Guardian (First Name)

(Last Name)

Relation

Parent/Guardian Phone

Parent/Guardian Email

Refferer’s Name

Did anyone reffer you to our college? If so please fill in the person’s details here

First Name

Last Name

Refferer’s Contact Number

Payment Details

Mode of Payment Process

Go to the Sim toolkit on your phone.

Under M-pesa select the lipa na M-pesa option.

Select the Paybill option: Paybill Number 522522

: Account Number 7521461

Enter amount to pay: Ksh.1,000

Enter your M-pesa PIN .

Confirm the details and press OK.

Input Transaction Code below

M-Pesa Transaction Code:

I have read and agree to the Terms and Conditions and Privacy Policy