ACOHAS - Accra College of Health and Allied Sciences

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Date of Birth (as on Birth Certificate)

Please enter your date of birth.

Full Name (as on Form Four Certificate)

Please enter your full name.

Gender

Please select your gender.

Region

Please select a region.

District

Please select a district.

Student Phone Number

Please enter a 10-digit phone number.

Student Email

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Have you completed O' Level (CSEE)?

Please select an option.

Form Four Index Number

Please enter the Index number.

Year Completed

Please enter a completion year between 1900 and 2025.

Primary School Attended

Please enter the name of the primary school.

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Next of Kin Name

Please enter the next of kin's full name.

Relationship

Please enter the relationship.

Next of Kin Address

Please enter the next of kin's address.

Next of Kin Phone Number

Please enter a 10-digit phone number.

Next of Kin Email

NOTE this application will be submitted for the course Ordinary Diploma in Clinical Medicine