INSTITUTE OF ACCOUNTANCY ARUSHA

P.O.Box 2798,Arusha | Tel:+255(0) 763 462 109/+255 27 254 9605 |Email: iaa@iaa.ac.tz |
Website: www.iaa.ac.tz

STUDENT’S REGISTRATION FORM

PART A: STUDENT PARTICULARS

1. NAME: MICHAEL LEONARD URASSA

2. SIGNATURE: ……………………

3. PERMANENT ADDRESS: Arusha tanzania 0788552099

4. STUDENT MOBILE NO: 0688516683, Email michaelurassa666@gmail.com

5. PROGRAM: Bachelor of Business Management

6. SPONSOR:.......................... Others (name) ........................................................................

7. ACCOMODATION: ......................

PART B: ACCOUNTS SECTION

He/She has paid a total of Tshs ……………………………………. through Cheque No. / Pay in slip F/No.
....................................... dated ......................................

NAME OF THE OFFICER …………………………… SIGNATURE ………………..

PART C: ADMISSIONS OFFICE

He/She has presented original certificates and other required documents, and he/she is eligible/not eligible for
registration in ……………………. program.

NAME OF THE OFFICER …………………………… SIGNATURE ………………..

PART D: DEAN’S OFFICE

He/she is allocated/not allocated in a shared room no. ………; Hostel name: ..........................

NAME OF THE OFFICER …………………………… SIGNATURE ………………..

DATE …………………………

20-10-2023 (Registration Form 1 & 2)

ACADEMIC YEAR _________________ REGISTRATION NUMBER__________________

PERSONAL INFORMATION: Full Name: MICHAEL LEONARD URASSA

Date of Birth:16/04/1998 Marital Status:Single Nationality :Tanzanian

Region:District: Address: Arusha tanzania 0788552099 Mobile Number :0688516683

Name and Address of Financial Sponsor :_______________________________________

ACADEMIC QUALIFICATIONS :

Primary School :Kibaoni primary schools Location :Karatu Year :2012

Form IV Index Number :S0169/0027/2018 Form VI Index Number/AVN :
Foundation Program :
from with GPA of , Year

ATTACHMENTS:
Disabilities :None
If any of the above give details of disability
___________________________________________________________________

EMPLOYMENT RECORD:
Position/Title
Employer Since
Work station
Responsibilities/duties

NEXT OF KIN :

Full Name : ROZA FILBARTH KIYARUZI

Relationship Mother
Postal Address:Arusha tanzania 0788552099
Telephone No.: 0692740255

STATEMENT BY THE STUDENT:

I hereby certify that the information I have given above is correct to the best of my knowledge.

Date:_________________ Signature: _______________________

Name & Signature of Admissions Officer:

Date _________________ Signature: _______________________

20-10-2023 (Registration Form 1 & 2)