Application Form

LOCAL GOVERNMENT TRAINING INSTITUTE
P.O.BOX 1125 DODOMA

Affix colored
Fax: 026 – 2961100
E- mail: [email protected]
Website: www.lgti.ac.tz Stamp Size
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Application Form for Admission into Certificate and Diploma Courses for Academic Year 2018/2019
1. Previous Application to the Institute
Have you ever applied for admission or registered in courses at LGTI: Yes No If yes, LGTI Reg. No
2. Personal Information (Please use capital letters)

Fill your names exactly as they appear in your academic certificates i.e. CSEE, ACSEE or equivalent qualifications
Last Name: Do You Have any Physical or Communication Disabilities?
Yes No
First Name and Middle Name(s) – Do not use initials If YES above tick whichever is applicable
Speech Hearing Mobility Vision Albinism Others
Date of Birth Sex Give details of disability:

Male Female
Place of Birth:
Citizenship: Please select residence category
Permanent Home Address:
Contact Address: In Campus
E-mail Address:
Applicant Mobile Number: Off Campus
Marital Status:
Next of Kin
Name:
Mobile Number:
Relationship:
Residence:
3. Proposed Course of Study
S/N Courses Tick(√) any Rate in

Three(3) in Order of
the Priority
Appropriate
Field (Write 1,2,3)
1. Basic Technician Certificate in Local Government Administration
2. Basic Technician Certificate in Local Government Accounting and Finance
3. Basic Technician Certificate in Community Development
4. Basic Technician Certificate in Human Resource Management
5. Basic Technician Certificate in Procurement and Supplies Management
6. Basic Technician Certificate in Records, Archives and Information Management
7. Ordinary Diploma in Local Government Administration
8. Ordinary Diploma in Local Government Accounting and Finance
9. Ordinary Diploma in Community Development
10. Ordinary Diploma in Human Resource Management
11. Ordinary Diploma in Procurement and Supplies Management
12. Ordinary Diploma in Records, Archives and Information Management
Sponsorship – Please select once
Private Government
Specify:
4. Education Background
a) Certificate of Primary Education Examination
School Name…………………………………………..
Region/District………………………………………...
b) Certificate of Secondary Education Examination (C.S.E.E.) or Equivalent
(Index Number …………………………………… Year of Completion
Subject Grade Subject Grade
c) Advanced Certificate of Secondary Education Examination (A.C.S.E.E.) or Equivalent

(Index Number …………………………………………………. Year of Completion ………………………………………
Subject Grade Subject Grade
d) Details of any other Qualifications e.g. Diploma, Certificate etc.

INSTITUTE/INSTITUTION From (Year) To (Year) Name of Award e.g. Certificate/Diploma
5. Sponsorship Declaration
I………………………………..…of……………..………….............. (Postal address) declare to sponsor……….………………
(Name of applicant) to study at the Local Government Training Institute-Dodoma and that I will pay all fees in time as required
including costs for Field Practical Training. My mobile no. is …………………………. and email address:
……………………………
Sponsor’s signature: …………………………………….. Date: …………………………………………………...
6. Applicant’s Declaration
I agree, if admitted to LGTI, to comply with institute regulations. I certify that the information in this application is true and
complete in all respects and that I have withheld no information. I authorize the institute to verify any information provided as
part of this application.
Applicant’s Full Name:

Applicant’s Signature: Date of Application:
7. Mode of Payment
1. Registration and identity card are paid only once during first year. Document to be Enclosed
2. Payments can be made in two installments (i.e. Semester I and You should include the following when sending your application:
Semester II.) as indicated in joining instruction form 1. Duly filled application form
3. Non-refundable application fee (Tshs.10,000/=) to be deposited in 2. Copy of Certificate of Secondary Education Examination (CSEE)
Account No: 50501100209 NMB Local Government Training 3. Copy of other qualification(s) e.g. certificates – if any
Institute 4. Copy of birth certificate
Note: 5. Original Bank Pay-in slip for application fee
1. All payment should be done through Local Government Training 6. Two recent passport size photographs
Institute Bank Account ONLY
2. Other recommended direct student costs (incurred by sponsors or For more Information or enquiries please contact:
students) are merely indicative The Registrar,
3. Students are advised to join the National Health Insurance Fund Local Government Training Institute (LGTI),
(NHIF)if you have not insured before P. O. Box 1125,
4. Fees structure is attached in appendix DODOMA,
5.This application form is also available at Local Government Training TANZANIA.
Institute (LGTI or you can directly download from our Website: Mob .no. 0717-487420 or 0754-415659
www.lgti.ac.tz
FEE STRUCTURE AND OTHER CHARGES APPLICABLE 2018/2019
NO. COST ITEMS CERTIFICATE ORDINARY DIPLOMA

PROGRAMMES PROGRMMES (ALL)
(ALL)
DIRECT COST PAYABLE TO THE (ONE YEAR) YEAR 1 YEAR 2
INSTITUTE
CITIZENS (TSH.) (TSH.) (TSH.)
1. Tuition Fee - Annually 660,000 760,000 770,000
2. Registration - Once 20,000 20,000 -
3. Examination Fee – Annually 30,000 30,000 30,000
4. Identity Card – Once 10,000 10,000 -
5. Students’ Union – Annually 20,000 20,000 20,000
6. Field supervision – Annually 50,000 50,000 50,000
7. Sports and Games – Annually 20,000 20,000 20,000
8. Foundation Course (Intensive English 10,000 10,000 10,000
Course)
9. NACTE Subscription 15,000 15,000 15,000
10. NHIF Registration Fee if you were not 50,400 50,400 50,400
insured before
TOTAL FEE 885,400 985,400 965,400
11. Accommodation – Annually 300,000 300,000 300,000
TOTAL FEE AND ACCOMMODATION 1,185,400 1,285,400 1,265,400
LOCAL GOVERNMENT TRAINING INSTITUTE FEE

ACCOUNT – NO. 50501100209 NMB
NON CITIZENS US $ US $ US $
1. EAC 1,100 1,200 1,200
2. Others 1,600 2,000 2,100
ITEMS PAYABLE DIRECTLY TO THE

STUDENT - RECOMMENDED
CITIZENS (TSH.) (TSH.) (TSH.)
1. Meal Allowance 1,785,000 1,785,000 1,785,000
2. Books and Stationery 150,000 150,000 150,000
3. Scientific Calculator 40,000 40,000 40,000
4. Field Assignment 280,000 280,000 280,000
5. Research - 280,000 280,000
6. Application Fee 10,000 10,000 10,000
7. Graduation Fee 30,000 30,000 30,000
TOTAL 2,315,000 2,595,000 2,595,000
NON CITIZENS US $ US $ US $
5,000 5,000 5,000
.
LOCAL GOVERNMENT TRAINNING INSTITUTE
P. O. Box 1125, DODOMA. Tel: 026 - 2961101, Fax: 026 - 2961100,

Email: [email protected]; Website: www.lgti.ac.tz
MEDICAL EXAMINATION FORM
To be completed by Medical Officer in respect of Institute Student (Entrant).
FULL NAME OF STUDENT………………………………………………
SEX: MALE/FEMALE ……………………………………………………..
HGB TEST ………………………………………………………………….
URINE MICRO …………………………………………………………….
T.B.TEST…………………………………………………………………….
EYE EXAMINATIONS ……………………………………………………
E.N.T …………………………………………………………………………
CHEST ………………………………………………………………………
CHEST X-RAY …………………………………………………………….
ABDOMEN …………………………………………………………………
SICKLE CELL TEST……………………………………………………….
R.B.G………………………………………………………………………..
ADDITIONAL INFORMATION
Physical Defects or Impairments, Infections, Chronic, or Hereditary (family) Disease.
…………………………………………………………………………
I certify that I have examined the above Student and consider that he / she is physically / not
physically fit for further studies.
DATE ……………………………….
SIGNATURE………………………
STATION………………………….
DESIGNATION………………….
OFFICIAL STAMP

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LOCAL GOVERNMENT TRAINING INSTITUTE

P.O.BOX 1125 DODOMA

1. Previous Application to the Institute

2. Personal Information (Please use capital letters)

Date of Birth Sex Give details of disability:

3. Proposed Course of Study

S/N Courses Tick(√) any Rate in

Sponsorship – Please select once

(Index Number …………………………………… Year of Completion

Subject Grade Subject Grade

c) Advanced Certificate of Secondary Education Examination (A.C.S.E.E.) or Equivalent

d) Details of any other Qualifications e.g. Diploma, Certificate etc.

Sponsor’s signature: …………………………………….. Date: …………………………………………………...

Applicant’s Full Name:

NO. COST ITEMS CERTIFICATE ORDINARY DIPLOMA

LOCAL GOVERNMENT TRAINING INSTITUTE FEE

ITEMS PAYABLE DIRECTLY TO THE

P. O. Box 1125, DODOMA. Tel: 026 - 2961101, Fax: 026 - 2961100,

MEDICAL EXAMINATION FORM

To be completed by Medical Officer in respect of Institute Student (Entrant).

FULL NAME OF STUDENT………………………………………………

SEX: MALE/FEMALE ……………………………………………………..

HGB TEST ………………………………………………………………….

URINE MICRO …………………………………………………………….

EYE EXAMINATIONS ……………………………………………………

CHEST X-RAY …………………………………………………………….

SICKLE CELL TEST……………………………………………………….

Physical Defects or Impairments, Infections, Chronic, or Hereditary (family) Disease.

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