VCMSHT Online Campus Application Form For Students VCMSHT ONLINE CAMPUS APPLICATION FORM Personal Information SectionPlease note that fields marked with asterisks are compulsory. You can only apply once (no duplicate entry) Surname* First Name* Middle Name Gender*choose your genderFemaleMaleState of Origin* Local Government of Origin* Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Passport Photograph*Please upload a Passport Photograph not more than 1MB in file size.Max. file size: 1 MB.Government Issued IDPlease upload a government-issued ID such as National ID Card/Voters Card/Passport/Driver’s Licence/ETC. You can skip this step if you do not have one.Max. file size: 1 MB.Guardian/Parent/Sponsor's Information SectionFull Name* Phone*Full Contact Address* Relationship With YouFatherMotherSisterBrotherAuntyUncleCousinSpousePlease choose an optionPhysical Contact Information SectionYour Street Address* City* State* Country* Academic Information SectionExam Type (First Seating)*WAECNECOGCENABTEBWAEC/NECO/GCE/NABTEB Examination Number (First Seating)* WAEC/GCE/NECO/NABTEB Result (First Seating)**Please list from 5 to 8 WAEC/NECO/NABTEB result subjects against the earned credits. *To add more field, press/click the “Circled Plus Icon”. *Grade should be in A1, B2…etc format.Subjects NameCredit Grade Please, only fill this section if you have two seatings in your “O” Level result. otherwise, leave blank Exam Type (Second Seating)WAECNECOGCENABTEBWAEC/NECO/GCE/NABTEB Examination Number (Second Seating) WAEC/GCE/NECO/NABTEB Result (Second Seating)*Please list from 5 to 8 WAEC/NECO/NABTEB result subjects against the earned credits. *To add more field, press/click the “Circled Plus Icon”. *Grade should be in A1, B2…etc format.Subjects NameCredit Grade VCMSHT Enrollment Information SectionYear of Entry into Your VCMSHT Program* Your Current Program At VCMSHT*Select one..Environmental Health Technology – 4 Years + 1 Year Internship.Environmental Health Technician Course- 3 yearsEnvironmental Health Assistant Course- 2 yearsCommunity Health Extension Workers Course (CHEW) – 3YearsJunior Community Health Extension Workers Course (JCHEW) – 2 YearsHealth Information Management (Technician) Course – 3 yearsMedical Laboratory Technician Course – 3 yearsProfessional Diploma in Health Informatin ManagementYour VCMSHT Matric Number* Please type in your matric numberInformation Validity ConfirmationValidity* I confirm that the information entered in this form is true to the best of my knowledge. NameThis field is for validation purposes and should be left unchanged.
