DMI - ST.

EUGENE UNIVERSITY
DMI
ZAMBIA Affix
Recent Passport
Size Colour
Photo
Fully Alive, Fully Human

CHIBOMBO CAMPUS CHIPATA CAMPUS

P.O Box 330081 P.O Box 511026
Great North Road St. Anne's Area, Chipata
Chibombo(Dist.) Ph: +260 977200088
Ph:+260 977613644
E-mail: [email protected] E-mail: [email protected]

Diploma Bachelor Degree Post Graduate APPLICATION FORM Application No.:

:
PERSONAL INFORMATION

1. Title: Mr. Ms. (Please Tick one)

2. Name of the Applicant: (In Capital Letters)

F I R S T N A M E M I D D L E N A M E

L A S T N A M E

3. Sex: M F 4. Date of Birth: D D M M Y Y Y Y 5. Age

6. Marital Status: Married Single 7. Nationality: 8. Religion:

9. Tribe: 10. Passport / NRC No.:

11. Identification Marks / I.

Birth Marks: II.

12. Address for

Communication:
Phone: E-mail:

13. Occupation, Official Address and Income of the Parents / Sponsor

Relationship Occupation Name & Official Address with P.O. Box No. Income (Per Annum)
1. Father Name:
Address:

Phone: E-mail:
2. Mother Name:
Address:
Phone: E-mail:
3. Guardian / Name:
Sponsor
Address:

Phone: E-mail:

Page: 1/7
14. Are you under Government
Sponsorship (If Yes, give
details of the department)

15. Academic Records :

Qualifications Boards / Unive rsity/College From To Subject Percentage / Result
with Address Grade

16. Any other courses done / completed?

17. Are you currently engaged in any studies? Yes No

If Yes, Specify the field of study and examining body.

Field of Study Name of the Institution Examining Body

18. Current Employment: Are you employed? Yes No If Yes, Organization Address.

19. Years of Service:

20. Groups Offered in First Year

The students are requested to mention the order of preference: (Mark any three groups)
S.No. Modules Order of Pref.
1. I Fundamental Mathematics Physics Chemistry Botany Zoology
English I & II I & II I & II I & II I & II I & II
2. II Fundamental Mathematics Physics Chemistry Computer Science -
English I & II I & II I & II I & II I & II
3. III Fundamental Physics Chemistry Botany Zoology -
English I & II I & II I & II I & II I & II
Fundamental Business Maths & Accountancy Commerce & Computer Science -
4. IV
English I & II Statistics I & II Economics I & II
Fundamental History Political Science & Geography Computer Science -
5. V
English I & II I & II Sociology I & II I & II
Fundamental Biology Home Science Food & Nutrition Computer Science -
6 VI English I & II I & II I & II I & II I & II

Page: 2/7
21. Order of Preference

The students are requested to mention the order of preference: (Mark as 1, 2 & 3)

Diploma Programmes – 3 years (Full time/Evening/Week End) Order of Preference

Programmes
Diploma in Computer Science
Diploma in Commerce
Diploma in Business Management
Diploma in Social Work
Bachelor Degree Programmes – 4 Years (Full time/Evenin g/Week End) Order of Preference
Bachelor of Science in Computer Science
Bachelor of Engineering in Computer Science (5 Years)
Bachelor of Science in Food and Nutrition
Bachelor of Business Administration
Bachelor of Commerce in Accounts and Finance
Bachelor of Social Work (Generic)
Bachelor of Arts in Secondary Education with English
Bachelor of Arts in Secondary Education with Civic
Bachelor of Science in Secondary Education with Mathematics
Bachelor of Science in Secondary Education with Geography
Bachelor of Science in Secondary Education with Chemistry
Bachelor of Science in Secondary Education with Physics
Bachelor of Science in Secondary Education with Biology
Bachelor of Science in Secondary Education with Computer Science
Master Degree Programmes – 2 Years (Week End) Preference
Master of Business Administration in Human Resource Management
Master of Business Administration in Finanace & International Business
Master of Business Administration in Marketing & Entrepreneurship
Master of Commerce in Accounts and Finanace
Master of Social Work in Community Development
Master of Social Work in Project Management, Monitoring and Evaluation
Master of Science in Computer Science
Master of Education in Educational Administration

No. Schools Groups Preferred / to be chosen in 1 st Year

1. School of Management Studies I, II, III, IV, V & VI
2. School of Commerce I, II, III, IV, V & VI
3. School of ICT I, II & IV
4. School of Engineering I & II
5. School of Medicine I & II
6. School of Social Work I, II, III, IV, V & VI
7. School of Education - Arts I, II, III, IV, V & VI
8. School of Education - Science I, II, III, IV, V & VI
9. School of Science and Humanities I, II, III, IV, V & VI

Page: 3/7
 DECLARATION

1. The above-mentioned courses will be offered only based on the number of students, who opt for the courses.
2. There will be no change of courses allowed or permitted, once the course has been opted.
3. The student can choose his/her course expressing three order of preferences compulsorily.
4. Once the course is selected, in no case the student will be permitted to change his/her course / specialization.
5. However, a student is permitted to change the Course / Specialization subject to the availability and size of the
course.

6. The students are permitted to transit from one school to another only on payment of K 250.
7. If the Group / Course is not offered due to the non-availability of the number of students, the fee collected will
be refunded except the application fee.
8. It is the right of the Management either to offer or to cancel any Course / Programme.
9. A student should give three preferences of the courses, which he/she opts for. If he/she does not mention the
three preferences, his/her application will be rejected.

10. The student is also permitted to change from one campus to another campus inside DMI - St. Eugene
University provided he/she should not have any dues at the parent campus and he/she should pay K 500 for
the transfer.

11. Tuition fees prescribed for various programmes will be uniform for all the campus colleges of the University.

I do agree to adhere to the aforesaid declaration.

Signature of the Candidate Signature of the Parent/Guardian/Sponsor

Place: Place:

Date: Date:

Page: 4/7
 MEDICALPROFORMA

1. Name of the Candidate :

2. Father / Guardian Name :

3. Sex: Male Female 4. Height: cm 5. Weight: 6. Blood Group:

7. Identification Marks: a.
b.

8. Whether the candidate fulfills the following standards : (If No, Specify the defect)
a. General Fitness consists of: : Yes No
Full Urine Test, Chest X – ray & ECG
Mental Retardness Test and
Other General Tests
b. HIV Test : Yes No
c. Vision : Yes No
d. Auditory functions : Yes No
e. Speech functions : Yes No

9. Whether Physically Challenged : Yes No

(If Yes, Specify the challenge (defect) and the extent of disability)
a. Vision
b. Speech
c. Hearing
d. Limbs

10. If having any allergy? : Yes No

(If Yes, Specify)

11. If having any chronic disease? : Yes No

(If Yes, Specify)

A. OPINION:From the above clinical details please

specify whether the candidate is physically fit to
be considered for admission in the University : Yes No (If No, Specify the reason)

B. Remarks:

Signature of the Applicant Signature of the Regd. Medical Practitioner

with seal

Place: Register No. :

Date: Full Address:

Page: 5/7
 DMI– ST.EUGENE UNIVERSITY
ZAMBIA
(Run by the Sisters of the Daughters of Mary Immaculate and Collaborators)
Website: www.dmiseu.edu.zm

STUDENTUNDERTAKING

I S/o. / D/o. / Ward of

has been admitted
in the Department of for the Diploma / Under Graduate
course in
subject to the following conditions:
1. I am aware that I have to secure not less than 85% overall attendance in a semester to make me eligible for the end
semester examinations, failing which I can be debarred from appearing the end exams.
2. I will abide by the rules and regulations of the University in force.
3. I pledge that I will not entertain any form of political activities or strike during the course of my study and I
guarantee that I will not cause any damage to any of the University property and if there is any breakage or misuse
of articles, I assure that I will replace the same or pay the stipulated amount as prescribed by the University
authorities.
4. I assure that I will pay all the fees mentioned in the fee structure within the stipulated date fixed by the authorities.
I am also aware that if I have not paid the fee in due date, my name will be struck off from the roll of the
University.
5. I will not raise any objection if the University is shifted to any new campus and if any additional expenses
incurred, it will be borne by me.
6. I also accept the termination of my scholarship if any, during the course of my study, if seen/found involved in any
illegal activities or mis-conduct.
7. I am aware that the University is not responsible for the loss/theft of any of my belongings and valuables.
8. I am aware that the University doesn't provide transport facility and any expenses for transportation from hostel to
University campus, Industrial Training and the expenses towards it will be borne by me.
9. I am aware that the University is not responsible for any loss or damage to the life and property of myself either
inside or outside the campus.
10. I am aware that the University fee once paid will not be refunded under any circumstances.
11. I am also aware that as a resident of the hostel (Boys/Girls), I will abide by the Rules and Regulations of the
hostel and in the event of my not complying with; I am liable for expulsion from the hostel and the college
simultaneously.
12. A candidate may be allowed to re-sit in his/her failed courses in Supplementary Examinations if he or she has
attained an overall GPA of 1.8 or above in the First Sitting calculated in accordance with the credit weightage
of individual courses. The maximum grade obtainable in a Supplementary Examination shall be the minimum
passing grade i.e. ‘C’.
13. A candidate who fails to attain an overall GPA of 1.8 will be discontinued from the courses.
14. To conclude, I will comfirm strictly to all undertaking listed above and other rules and regulations put forth by
the University then and there. If I fail to adhere to any of the above stated undertaking, I will not be eligible to
write the End Examinations.

Signature of the Candidate Signature of the Parent/Guardian/Sponsor

Place: Place:

Date: Date:

Page: 6/7
 INSTRUCTIONS

The Application Form has to be duly filled in by the candidate and has to be submitted along with the
following particulars: (Tick the Appropriate one)

1. Recent passport size photos – 5 copies Yes No

2. School Leaving Certificate - 2 sets attested by Commissioner of Oaths or Notary Public Yes No

3. Degree / Course Certificate / Marks Sheets – 2 sets attested by Commissioner of Yes No

Oaths or Notary Public

4. Conduct Certificate from previous Head of the Institution / Organization Yes No

5. Medical Proforma filled by Regd. Medical Practitioner (Application Form page 5) Yes No

6. Date of Birth Certificate or NRC or Passport – 2 sets attested by Commissioner of Yes No

Oaths or Notary Public

7. Fee Receipt – Photocopy Yes No

8. Original Bank Deposit Slip Yes No

9. Joint declaration in the student undertaking form by candidate and Parent/ Yes No
Guardian/ Sponsor

10. All payments should be made only through Bank Account

FOR OFFICE USE ONLY

Payment Details :
Amount in words :
Mode of Payment : Bank Receipt Cheque
Bank Name :
Bank Receipt /Cheque Date :
Bank Receipt / Cheque No. :

Cashier/Accountant

FOR OFFICE USE ONLY

Register No. :

Group Selected in the First Year : I II III IV V VI

Programme Approved for Admission:

Remarks :

Registrar
Page: 7/7
 DMI-St. Eugene University, Zambia
With Effect from 2019 Intake
AMOUNT
OTHER FEES Diploma and Bachelor
Post Graduate
Degree
Application Fees K 100 K 150
Registration Fee K 250 K 250
Identity Card K 100 K 100
Caution Deposit (Refundable at the end of the course) K 250 K 250
Club Activities K 100 K 100
Sports Fees K 100 K 100
Industrial Visits K 100 K 100
Accommodation fee for Students (Per Semester) K 3,000 K 3,000
NOTE
1. No Examination fees for the regular modules
2. Application fee and examination fee should e paind by the students taking supplementary modules
3. Students should make their own arrangements for the stationary.
4. All payments should be made in the school Account given below:
Bank Name: INDO Zambia Bank (Main Branch)
A/C No.: 0011040002475
A/C Name: Trust of DMI and Collaborators
CONTACT US ON THE FOLLOWING
Great North Road Campus Chipata Campus
P.O. Box: 330081, P.O.Box: 511026
Plot No. B2029/M, St. Anne’s, Area
9 Miles, Great North Road, Chipata, Zambia.
Chibombo, Zambbia. Ph. No; + 260 977 200088
Ph. No: +260 977613644/09971004055/098524773 Email: [email protected]
Email: [email protected]

THANK YOU FOR VISITING US GOD BLESS YOU