Student Registration Form

First Name*

Second Name*

Course* -- Select Course -- Diploma in Community Health Nursing(DCHN) Diploma in Perioperative Theatre Technology Certificate in Perioperative Theatre Technology Diploma in Community Health Assistant (Level 6) Certificate in Community Health Assistant (Level 5)

Grade*

Phone Number*

Email Address*

Parents/Guardians Names*

Parents/Guardians Phone Number*

County*

Sub County*

MPESA Transaction Code*

Mobile payments through M-Pesa Paybill

Pay KSh 2,000

Business No: 522533

Account No: 8249941# followed by your first name