LAKE INSTITUTE OF TROPICAL MEDICINE( LITMED)
KERUGOYA
litmedkerugoya@gmail.com
+254 713 874 535
Application Form
Personal details
Surname
*
First Name
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Other Names
Gender
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-- select gender --
Male
Female
Other
Academic & contact
Mean Grade
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---- select grade ----
A
A-
B+
B
B-
C+
C
C-
D+
D
D-
E
Certificate
Artisan
Phone
*
Email
*
Date of birth
*
Location & identification
Nationality
*
National ID
County
*
District
*
Course & intake
Course
-- select course --
Diploma in Perioperative technology
Certificate in Perioperative technology
Certificate in Health Services Support
Caregiver Course
Diploma in Community Health
Certificate in Community Health
Artisan in Community Health
Diploma in Social Work & Community Development
Certificate in Social Work & Community Development
Diploma in Science Laboratory Technology
Certificate in Science Laboratory Technology
Diploma in Agricultural Extension
Certificate in Sustainable Agriculture for Rural Development
Diploma in Analytical Chemistry
Diploma in Applied Biology
Diploma in Food Technology
Certificate in Food Technology
Computer Packages
HIV Testing Services (HTS)
Adherence Counselling
Bridging Course
Artisan in Sustainable Agriculture
Artisan in Agriculture and Extension
Intake
*
---- select intake ----
May
January
April
July
Sep
Oct
Year expected to join
Parent / guardian
Parent / Guardian
Relationship
WhatsApp Phone
Town & additional info
Town
*
Note:
All fields marked with
*
are required.
Consent & Acknowledgement
I acknowledge that submitting this application does not guarantee admission to Litmed College. I confirm that the information provided is true and accurate, and I consent to the collection and use of my personal data for admission, academic, and communication purposes. I understand that providing false information may result in disqualification or withdrawal of admission.
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