This document appears to be a student membership registration form for the University of Dodoma Muslim Students Association (UDOMSA). The two-page form requests information such as the student's name, degree program, registration number, place of domicile, sponsorship details, personal details, addresses, contact information, academic background, leadership experience, religious studies, and marital status. It informs students to affix necessary documents such as a passport photo.
DUST OF SNOW_BY ROBERT FROST_EDITED BY_ TANMOY MISHRA
REGISTRATION FORM YA UDOMSA
1. ب م ل ر م رح م
ِ ِسْ ِ ا ّ ال ّحْ َنِ ال ّ ِي
THE UNIVERSITY OF DODOMA MUSLIM STUDENTS ASSOCIATION
UDOMSA
P.O.BOX 1160 DODOMA
Email; udommuslim@yahoo.com/udommuslim@gmail.com
www.udomsa.blogspot.com or www.udomsa1.blogspot.com
STUDENT MEMBERSHIP REGISTRATION FORM
FORM NO: ________________
FULL NAME: _______________________________________________ ____________ _____________________
DEGREE PROGRAME: __________________________________________________ [ AFFIX ]
REGISTRATION NUMBER:-_T/UDOM/___________________________ [ ]
PLACE OF DOMICILE (Tick as appropriate): TANZANIA MAIN LAND ( ), [ PASSPORT ]
TANZANIA ZANZIBAR ( ) [ ]
SPONSORSHIP (Tick appropriate) PRIVATE { } GOVERNMENT{ } [ ]
Means Test Grade_____ -% ____ [ HERE ]
PERSONAL DETAILS [_______________ __]
SIR NAME__________________________ FIRST NAME___________________________
MIDDLE NAME______________________
DATE OF BIRTH___________________GENDER SEX ;( Tick appropriate) MALE ( ) / FEMALE ( )
ADDRESSES:
*PERMANENT ADDRESS * CURRENT ADDRESS
P.O.BOX_______________ P.O. BOX ___________________
________________________ ___________________________
________________________ ___________________________
TELPHONE NUMBER(S):
1. _________________________ 2. _________________________ 3._______________________________
FAX NUMBER: ________________________
________________________________________________________________________________________________
ACADEMIC BACKGROUND:
LEVEL NAME OF SCHOOL PLACE
- PRIMARY EDUCATION ________________________________, ____________________________.
- SECONDARY (O-LEVEL) _________________________________, ____________________________.
- SECONDARY (ADVANCE) _________________________________, _____________________________.
OTHER ACADEMIC QUALIFICATION(Tick as appropriate)
CERTIFICATE{ } DIPLOMA { } ADVANCED DIPLOMA { }
OTHER (Specify) ______________________________________________________
LEADERSHIP EXPERIENCE: POST PLACE YEAR
______________________________ _____________________ ________
______________________________ ______________________ ________
______________________________ ______________________ _________
RELIGIOUS STUDIES ATTAINED:
__________________________________________________________________________________________________
MARITAL STATUS (Tick as appropriate)
SINGLE { } MARRIAGE { }
PAGE 1 of 2 Authorized by Department of Publicity and Relation –UDOMSA 2010®