APPLICATION FORM

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APPLICATION FORM FOR TERNET MEMBERSHIP
The Information you provide will be held and processed at TERNET secretariat and associated organs databases and used only for the purpose of supporting your institution. It will not be supplied to any external body for any other purpose without your institution consent.
This form should be completed by the institution requesting membership and submitted online. If you are facing difficulties to complete the form, please contact us at helpdesk@ternet.or.tz.
Note: Your institution will be required to pay one-time subscription fee of Tanzanian Shillings one million five hundred thousand only (Tshs. 1,500,000) and annual membership fee of Tanzanian Shillings five hundred thousand (Tshs.500, 000) to two million five hundred thousand (Tshs 2,500,000) depending on the institution's category and/or number of students in the current academic year.
FORM COMPLETED BY
Full Name: (*)
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Designation (*)
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E-mail Address (*)
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Mobile Number (*)
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Date (*)
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What is the total number of students in this academic year? (*)
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SECTION 1: ABOUT THE INSTITUTION
Name of the Institution (*)
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Telephone No: (*)
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Fax no: (*)
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E-mail address (*)
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Location (*)
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Please upload a document with the list of other campuses the institution has. Remember to include contacts of each campus.
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SECTION 2: INSTITUTION CONTACTS
Administrative contact (if not as above)
Name (*)
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Telephone (*)
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Fax no
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Mobile number:
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E-mail (*)
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Head of ICT department
Full Name (*)
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Telephone (*)
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Fax
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Mobile number:
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E-mail address: (*)
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Technical Contact (If not as above)
Name
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Telephone
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Fax no:
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Mobile number:
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E-mail address:
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Finance Contacts
FullName (*)
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Telephone (*)
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Fax no
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Mobile number
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E-mail address (*)
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SECTION 3: SUPPORTIVE INFRASTRUCTURE
Please provide details of your infrastructure.
Does your institution have a network backbone connecting all building LANS? (*)



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What type of media are used? (*)






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How much Internet bandwidth (Mbps) does the institution currently subscribe for?(Downlink/uplink) (*)
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How much does the institution currently spend on bandwidth? (*)
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Who is the current institution's Internet Service Provider? (*)
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What is your general use of the Internet? (eg Distance Learning, Communication....)
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SECTION 4: DECLARATION
I confirm that: (*)



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FORM SUBMITTED BY
Full Name: (*)
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Designation (*)
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Mobile No (*)
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E-mail (*)
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Date (*)
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Initials (*)
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CONTACT US

Tanzania Education and Research Network(TERNET)
P.O. Box 95062, Ali Hassan Mwinyi Road,
Kijitonyama (Sayansi ) COSTECH Building,
Dar es Salaam, Tanzania,
Email: helpdesk@ternet.or.tz, noc@ternet.or.tz
Tel:    +255222775378
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