The allied health professionals council ministry of health
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| THE ALLIED HEALTH PROFESSIONALS COUNCIL
MINISTRY OF HEALTH 
APPLICATION FORM FOR REGISTRATION-AHPC-form 1 1. i) Individual information (Block letters) Surname: …………………..................................................First Name: …………………………………………………………… Other names: ……………………………………………………………
Nationality: ……………………………………………………….Country: ………………………………………………………….……………. District: ……………………………………..…. …………………Sub county: ……………………………………………………………………. Marital Status: …………………………………………………Tribe: ……………………………………………………….……………..……... ii) Contact Adress i) Personal Address: ……………………………………………………………. Residence: …………………………………………………………………. Telephone No: ………………………………………………..…Alternate Telephone No:……………………..………………………. Email address: …………………………………………………………………..……………………………………………………………………… ii) Work Place Place of work:.………………………………………………………………………………………………………………………………………… Address: ………………………………………………………………Telephone No:…………………… ……………………………………. Locality:…………………………………………………………………District:…………………………………………………………………. 2. Education information Secondary School attended :( Please attach copies) O’ Level: ……………………………………………………………… Index Number………………………………………………………………. A’ level: …………………………………………………………………Index Number:…………………………………………………………….. 4. Training information Training Institution: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………… Country of Training: ……………………………………………………………………………………………………….…..………………………… Contact address of Institution: ………………………………………………………………………………….……………………………..…… Tel number………………………………………………………… E-mail …………………………………. ……..………………………………….. Intake date: …………………………………………….……………Date of Completion: ………………..…………………………..………… Reg No ……………………………………………………………….. Hospital of training: ………………………………….…………………… Qualification type: 
Qualification: ……………………………………………………………………………….…………………….…………………………………………………. Cadre: ……………………………………………….……………………………….…………………………………………………………….…………… Have you ever registered before? (If yes, attach details) …………………………………………………………………………….. Date of registration: ………………………………………………… Signature……………………………………..……………………..
Registration no: ………………………………………….. Date of verification: …..……………………………………………..……….. Comments:………………………………………………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………………………………..……………………………………………………………………………………………………………………………………………………..………………..…… Name…………………………………………………………..……Title:……………………………………signature……………………………….. P.T.O Directory: uploads -> documents documents -> The Truth about the Rwandan Genocide documents -> Ap u. S. History presidents list the Young Republic, 1788-1815 documents -> Introduction documents -> Birth of a Monster on the left hand side of the page. Read all the interesting information as you make your way down to the chart which outlines the steps in hurricane formation. Hurricane Formation documents -> History of the American Automobile documents -> Exploring Hurricanes documents -> Famous Alabamians: Athletes documents -> The Baseball Project — Download 19.17 Kb. Share with your friends:
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