Online Application Portal

PLEASE COMPLETE THIS FORM TO BE CONSIDERED FOR ADMISSION AT ZAMBIA INSTITUTE FOR MEDICAL & PSYCHOLOGICAL STUDIES.

PART 1. (PROGRAMME/COURSE DETAILS)

PLEASE CHOOSE YOUR DESIRED PROGRAMME/COURSE OF STUDY

FIRST CHOICE

SECOND CHOICE

INTAKE

PART 2. (PERSONAL INFORMATION)

GENDER
MaleFemale

DATE OF BIRTH

NATIONALITY

NRC NUMBER (IF NON-ZAMBIAN ENTER PASSPORT NUMBER)

PART 3. (CONTACT DETAILS)

PHONE NUMBER(s)

EMAIL ADDRESS

PART 4. (NEXT OF KIN)

NAME

RELATIONSHIP

ADDRESS

PHONE

EMAIL ADDRESS

PART 5. (ACADEMIC, PROFESSIONAL BACKGROUND & PERSONAL )
Enter previous education institution attended (Secondary & University/college)

INSTITUTION 1

INSTITUTION 2

ARE YOU CURRENTLY EMPLOYED?

IF EMPLOYED

ENTER EMPLOYER

PERIOD OF EMPLOYMENT

POSITION HELD

NATURE OF RESPONSIBILITY

PERSONAL BRIEF

HOW WILL THE PROGRAMME/COURSE OF STUDY AFFECT YOUR CAREER DEVELOPMENT?

DO YOU HAVE ANY PERMANENT INJURY, ILLNESS OR DISABILITY WHICH MAY AFFECT YOUR ABILITY TO STUDY?

IF YES, PLEASE DESCRIBE THE NATURE OF INJURY, ILLNESS OR DISABILITY.

HOW DID YOU KNOW ABOUT ZIMPS PROGRAMMES?

PART 6 (UPLOADS, COUNTER CHECKING & DECLARATION)
UPLOADS

High School Certificate/Statements of Results

NRC/Passport

Passport Type Photo

Deposit Slip, (If Paid Application Fee by Mobile Money Enter REF Number)

CONFIRMATION, PLEASE USE THE BOX BELOW TO CONFIRM THAT YOU HAVE COMPLETED THE FORM AND ADDED ALL THE NECESSARY DOCUMENTS (INCOMPLETE APPLICATIONS WON'T BE CONSIDERED)

DECLARATION