Please enable JavaScript in your browser to complete this form.Application File Number *DEH/2020DHLM/2020DHPE/2020HAP/2020HIP/2020Course Application Year!Academic Year of Admission *2019/202020/212021/222022/23Name *FirstMiddleLastPhone NumberEmail *Please enter your email, so we can follow up with you.Sex *MaleFemalePrefer Not to SayPhysical Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia (Republic of)MadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States of AmericaUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweCountryEntry Scheme *Direct EntryCertificateMature EntryPlease select your entry schemeBASIC COURSE INFORMATION (Tick the Appropriate box). Please note, if you select course in this field don't select for Post Basic belowDiploma in Environmental Health Sciences (DIP.EHS)Certificate in Environmental Health Sciences (CERT.EHS)This section is only for Basic Courses on private Sponsorship Scheme. Select the appropriate coursePOST BASIC COURSE INFORMATION (Tick the Appropriate box) (copy). Please note, if you select course in this field don't select for Basic Course aboveDiploma in Environment Leadership and Mgt (Weekend)Diploma in Environmental Health Sciences (Upgrading - Weekend)Diploma in Environmental Health Sciences (Upgrading - Fulltime)Diploma in Health Promotion and Education (Weekend)This section is only for Post Basic Courses on private Sponsorship Scheme Through Upgrading Scheme.ADMISSION ENTRY SCHEME *Private Entry (DHLM & HPE)Mature Entry - Private Sponsorship Scheme (DEHS)Certificate (credit) Entry - Government Sponsorship Scheme (DEHS)Certificate (credit) Entry - Private Sponsorship Scheme (DEHS)This section is only for Post Basic Courses on private Sponsorship Scheme Through Upgrading Scheme.Education Background *FirstMiddleLastFirstMiddleLastFirstMiddleLastEmployment/Work Background *FirstMiddleLastFirstMiddleLastFirstMiddleLastDisabilities and Special NeedsYesNoDo You have any disability? If yes, what type of disability/special need ?If yes, Reason!Medical InformationYesNoDo You have any chronic infection? If yes, what infection?If yes, Reason!Funding and Sponsorship Information *In one InstallmentIn Two InstallmentsIn Three InstallmentsHow do you plan to pay your fees?Attach Passport Photo, Academic Documents or Practicing License (for Post Basic Programmes) and Payment Slip Click or drag files to this area to upload. You can upload up to 5 files. Application fee is: Basic courses (DEHS and CEHS-direct entry): Ugshs. 32,300 and DEHS upgraders and Post Basic courses i.e. DHLM and DHPE: 52,300; all fees are payable to: School of Hygiene-Mbale, account DFCU Mbale Branch a/c no. 01983501005221Declaration *I agree to SoHM term and conditionsI hereby declare that the inforamtion given above is true to the best of my knowledge and any case(s) of wrong information and impersonation whenever dicovered will lead to automatic cancellation of the admission.EmailSubmit 2019-12-04