Apply to ROCHTEC

ROCHTEC Application Form

Please complete the form below. Our admissions team will contact you after reviewing your application.

Personal Details

Full Name *

Date of Birth *

Gender *
Select GenderMaleFemalePrefer not to say

Phone Number *

Email Address *

Home Address *

State / Country of Residence *

Course Selection

Preferred Course *
Select CourseDiploma in Environmental HealthDiploma in Community HealthCommunity Health Extension Worker (CHEW)Junior Community Health Extension Worker (JCHEW)Diploma in Public HealthCare of the Elderly (Certificate)Mental Health & Social CareO-Level Preparation

Study Mode *
Select Study ModeFull-timePart-timeOnline

Preferred Intake *
Select IntakeJanuary IntakeMay IntakeSeptember Intake

Education Details

Highest Qualification *
Select QualificationO-Level / WAEC / NECOONDHNDDiplomaDegreeOther

School Last Attended *

Year Completed

Do you have the required O-Level subjects? *
YesNoIn progress

Upload Documents

Upload Academic Certificates

Upload ID / Passport

Upload Passport Photograph

Emergency Contact

Emergency Contact Name *

Emergency Contact Phone Number *

Relationship to Applicant *

Declaration