TANZANIA PARENTS ASSOCIATION H IVUMWE SECONDARY SCHOOL, P.0.BOX 1054, x :255736608025 REE.NO. JW/SSMB/INI88(29. Date — PPLICATION FORM FOR FORM V_ ADMISSION 2016 PART [: PERSONAL DETAILS (2) Full name — ----(0) Sex(female/male (c)_ Date of birt (@)_Place of birth (e) Religion (8) Residence (@ Parent/guar (O) Parents quardian’s address i) Occupation (k) Nationality PART 2: DETAILS OF NATIONAL FORM IV (C.SEE) RESULTS. a) Name of previous school (b) National examination index no ——— Foetetnd (c) Did you re-sit the national form iv examinations? yes/no (tick) Ifyou re-sit the national form iv examinations, fil in Your other index no. and the year of the examination in the apace provided below. Index no ————---------year (@) Results ofthe national exominations should be attached sui suBsEecT PIVICS: KISWAHILI HISTORY BIOLOGY GEOGRAPHY BASIC MATHS \GLISH PHYSICS CHEMISTRY COMMERCE BOOK-KEEPING AGRICULTURAL SCIENCE LITFRATURE IN ENGLISH DIVISION NO.OF POINTS “iePART 3 SUBJECT COMBINATIONS. (Choose one combination from the following combinations offered by the school (a) History, Geography, English Language (HGL) (b) History, Geography, Kiswahili (HGK) (©) History, Kiswahili, English Language (IIKL) PART 4 RETURNING THE FORM. ‘After filling in 2010 PART RESULTS OF THE SELECTION. Will be posted on 19" March 2010. 10 the Headmaster's office before 15"" March PART 6: OTHER DOCUMENTS. Attach to this form (WITHOUT FAILURE) the following, (a) A photocopy of Academic certif (b) Come with the Originals for veri ie or the Results slip 7. Signature of Applicant. — E.P. Muhondwa THE HEADMASTER