Application form for admission

ZIMPS APPLICATION FOR 2025 / 2026 ACADEMIC YEAR 1/6

Make sure you have deposited an amount of K200 to apply for diploma programmes or An amount of K150 to apply for Certificate programs scan the deposit slip, it will be used as proof of payment.
Use 0966287198 MTN or 0971587726 Airtel.

BANK PAYMENTS SHOULD BE MADE THROUGH THE FOLLOWING ACCOUNT
1. BANK NAME: ZANACO
2. ACCOUNT NAME: ZAMBIA INSTITUTE FOR MEDICAL AND PSYCHOLOGICAL COUNCELLING
3. ACCOUNT NUMBER: 5734911500168
4. BRANCH: ANY ZANACO BRANCH

SELECT YOUR PROGRAMME Registered Nursing Psychosocial Counselling Psychosocial Counselling Distance Clinical Medicine Environmental Health Technology Registered Nursing July 2022 Public Health Diploma General Agriculture Diploma in Agriculture - Crop Science Diploma in Agriculture - Business Management Nursing Health Care Assistant Pre- Medical HCA Fast Track (for Medical Professioanals) Psychosocial Counselling First Aid First Aid & CPR Cardiopulmonary Resuscitation (CPR): First Aid Cardiopulmonary Resuscitation (CPR)

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Please select a progamme

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Applicant Details 2/6

First Name

Sur Name

Gender Female Male

Date of Birth

Select Marital status Single Married

Nationality

NRC/Passport

Phone number

Email

Residential Address

Do you have a aby, permanent injury, illness or disability which may affect your ability to study ? No Yes

Please describe the nature of the injury, illness or disability

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Next of Kin 3/6

First Name

Sur Name

Gender Female Male

Relationship with applicant Father Mother Sister Brother Uncle Aunt Cousin Husband Wife

Phone number

Email

Residential Address

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Professional Qualification 4/6

Choose Subject and Grade

Mathematics English Biology Chemistry Computer Science Metal work Civic Education Human and social biology Additional Mathematics Geography Physical Science Gen. Science History Art Other Geometric Drawing English Literature Agriculture Science Principles of Accounts Homecraft/Cookery French Languages Religious Education Technical drawing Business studies 1 2 3 4 5 6 Add Sub

Are you Employed ? No Yes

Employer

Position

Period of Employment

Nature of Responsibility

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Scholarship (recommended) 5/6

Do you wish to have a Scholarship No Yes

When you apply for a Scholarship, Our School will pay for 75% of your total turtion fees.

Please Justification why you are applying for a Scholarship

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Payments and Attachements 6/6

Certfied Copy of National Registration Card / Passport

Deposit slip/Transfer Screenshot

Statement of Results/Certificate

Scholarship Recommendation Letter

Application Declaration

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I declare that the information I have supplied on this form is to the best of my knowledge complete and correct. I acknowledge that my application for enrolment is subject to acceptance by the institution.

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That all documents supplied with this application form are legal and not fraudulently obtained.

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I further acknowledge that in the event my application for enrolment as a student is accepted by the institution, I will be bound by the provisions of the relevant Student statutes, Rules and policies of the institution that are in force and lawful instructions from institutional authorities.

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I fully understand and agree with the above stipulations.

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