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First Name:
Last Name:
Other Names:
Program:
Marital Status:
Gender:
Academic Year:	Academic Semester
Mode of Study:
Highest Qualification:
Medical Record:
Date Of Birth:	eg. dd/mm/yyyy
Nationality:
NRC (or Passport If Non - Zambian)
Password:
Confirm Password:
Contact Details
House Number:
Street:
Town:
Province:
Country:
Email:
Postal Address:
Phone:
Employer:
Next of Kin Contact Details
Next of kin's names:
House Number:
Street:
Town:
Province:
Country:
Email:
Phone:
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Chengelo Nursing College
P.O. Box 410928, Northern Province-Zambia
Kasama
Off Mpika road
0966000291