APPLICATION FEE REFERENCE (for office use only) ……………………………………

ZIMBABWE SCHOOL OF MINES

Serving the SADC Mining Industry
Coghlan Avenue Ext. P.O. Box 2745
Killarney Bulawayo
Bulawayo Zimbabwe

Tel: (263) (09) 291247 or 291598 Cell: 0772 259 742

Tel: (263) (09) 290595/9 Fax: 09-291246

Email: registry@zsm.co.zw Website: www.zsm.ac.zw

APPLICATION FORM. – CERTIFICATE & DIPLOMA COURSES (2022/2023 INTAKE)

SECTION 1: PERSONAL DETAILS

I.D. NUMBER DATE OF BIRTH

PASSPORT NUMBER CELL NUMBER

BLOCK LETTERS

Surname…………………………………………..…………………………… Birth Cert No. …………………………………

First Names (in full) : …………………………………………………………………… Place of Birth …………………………………
Title Mr/Mrs/Miss/Dr/Professor …….……… Marital Status ……………… …….. Gender : Male Female

Nationality ……………………………………………………………………………….. Religion ……………………………………….

Address…..............................................................................................................................................Town/City ........................
Email address (as it appears and write clearly) ………………………………………………............................................................

Guardian/ Next of Kin (Name)…………………………………………..………………… Relationship ………………………………...

Postal & Physical Address …………………………………………………………………………………………………………………..
Contact No(s)…………………………………………..…… Email (mandatory): ……………………………………………………..

SECTION 2: EDUCATIONAL DETAILS (Subjects at ‘O’ Level)

Total number of subjects passed at ‘O’ Level with C or better
SUBJECT SYMBOL(S) EXAM BOARD

English Language
Mathematics
Science Integrated Science Chemistry Physics Physical Science Combined Science

(Tick science subjects passed and write symbols under ‘Symbols’ column)

SECTION 3: COURSE APPLIED FOR

Duration - 3 years (Fulltime)

Diploma in Metallurgical Assaying Executive Diploma in Mine Management – 1 year (Block)

Diploma in Mining Geology Certificate in Small-Scale Mining – 1 year (Full-time)

Diploma in Mining Engineering

Diploma in Mine Ventilation & Environmental Engineering

Diploma in Metallurgical Engineering

Diploma in Mine Surveying

D Diploma in Mining Engineering (Shaft Technician)

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 APPLICATION FEE REFERENCE (for office use only) ……………………………………

SECTION 4: COMPANY/PERSON PAYING FEES (Compulsory for ALL applicants)

Name of Company paying fees (if applicable) ………………………………………………………………………………………….

Name of person paying fees ……………………………………………………………………………………………………………....
Cell No(s) ………………………………………………………………………… Tel …………………………........................
Email ……………………………………………………………………………… Fax …………………………………………
Address ………………………………………………………………………………………………………………………......................

SECTION 5: EMPLOYMENT DETAILS

Are you currently employed? YES/NO ………………. if “YES” complete the following:

Employer ……………………………………………………………………………………………………………………………………....
Address ………………………………………………………………………………………………………………………........................
Your Job Title ………………………………………………… ………………………………………………………………………………
Contact Person …………………………………………………………………………………………………………………….............
Contact No ………………………………………… E-mail ………………………………………………………………..

How did you know about Zimbabwe School of Mines ……………………………………………………………………..

SECTION 6: DECLARATION (To be completed by ALL applicants)

a. I hereby certify that the above particulars are correct.
b. Should it be necessary, I hereby authorize the Z.S.M. to make any enquiries relevant to the acceptance of this application.
c. I agree that my signature on this form binds me to all the School regulations and conditions as they relate to students.
d. I accept that the Application Fee I am paying is non-refundable, regardless of whether I get selected for learnership.
e. I undertake to pay fees and any other dues on or before due dates.
f. If I wish to relinquish my studentship, I understand that I must give one-month notice in writing and immediately pay all moneys
owing or all unpaid studentship fees for previous years.

APPLICANT`S SIGNATURE……………………………………………………. DATE …………………………………………..

PRINT FULL NAMES ……………………………………………………............................................................................................

FOR OFFICE USE ONLY:-

Comment: …................................................................................................................................................................................

Registry: ______________________________ _________________________ __________________

Name Signature Date

Attach Certified copies of your: -

• National I.D.
• Birth Certificate.
• Educational Certificates (Certificates only – results slip not acceptable). Maximum of 2 sittings; 2 A
levels an added advantage.
• Professional Certificates (Diploma or degree required for the Executive Diploma in Mine
Management plus two years managerial experience in the mining sector).
❖ Proof of payment for the application fee of ZW$3,000.00.
Bank Details Bank ZB (for RTGS / Bond only)
Account Number 4370 755374 080
Branch Fife Street
Swift Code ZBCOZWHX
Ecocash Payments Use the PayNow facility. Visit – www.topup.co.zw ; Under Tuition Fees for Zimbabwe School of Mines; Use
Student Number C000007; Code/item is ‘Application fees’.

Application Form Hand delivered by: __________________________ ______________________ ______________

Full Name Signature Date

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