ADMISSION FORM Please enable JavaScript in your browser to complete this form.ORIGIN COLLEGE – MEDICINE COUNTER ASSISTANT ADMISSION SLIP *Yes, I agree– By submitting this form, I confirm that the information provided is accurate and true to the best of my knowledge. – I understand that providing false information may result in consequences, including rejection or expulsion. – I consent to the collection and processing of my personal data for the purposes of my admission to the Medicine Counter Assistantship programme. Preferred Campus *TemaSpintexType of Enrollment *New StudentRetraining StudentSessions Offered *MorningEveningWeekend (Saturday & Sunday)Full Name *FirstLastMobile Number *Email Address *Residential AddressGPS AddressID Type *ID Number *Nationality *Date of Birth *FORMAT: DAY/MONTH/YEAR (e.g. 01/04/2002) Sex *MaleFemaleMarital StatusSingleMarriedDivorcedFather / Guardian's Name *FirstLastFather / Guardian's Mobile Number *Mother / Guardian's Name *FirstLastMother / Guardian's Number *Father / Guardian's OccupationName of High School Attended and Period *Final Grade in English *Final Grade in Core Mathematics *Final Grade in Integrated Science *Name of University Attended (if applicable)Work Experience (if any)Admissions Processing Fee – Enter Transaction ID *Cost = GHC 100.00 || Momo Number = 0598632644 || Account Name = ORIGIN COLLEGE LTD. || Enter your FIRST NAME as the “REFERENCE” || Then, make sure to enter the Transaction ID in the field above: Who will be responsible for your fee payments? *ParentsGuardianChurchCompany / BusinessPersonal / OtherSELECT AS MANY AS APPLIESState the full name of the person(s) / institution(s) above *FirstLastCurrent place of residence (of the above) *Phone / Contact Number (of the above) *Ghana Card Number (of the above) *Submit
