Online Application Form

STUDENTS ADMISSION FORM

(To be completed in duplicate and returned to the college within specified period)

A. STUDENT/APPLICANT PERSONAL DETAILS

Upload Passport *

Drop your file here or click here to upload passport

Upload files: KCSE certificate for Certicate of Diploma Courses

Drop your file here or click here to upload

Upload files: KCPE certificate for Artisan Courses

Drop your file here or click here to upload

Name (in full) *

Gender *

Male
Female

Date of Birth

ID/ Passport Number *

Email *

Nationality *

County

Village

Town

Permant Address: *

Parents's phone No: *

If employeed Business Address

Company's Name

Town

PO Box

Tel

B. PARENT/GUARDIAN DETAILS

Who will be funding your studies(fill in his/her details below) Name of Kin/Guardian

Guardian Name *

Position

Referee *

Guardian Tel *

Signature

Contact *

Realtionship *

Date / Time

Sign

C. ACADEMIC AND PROFESSIONAL QUALIFICATIONS

(Please indicate the qualifications achieved starting with the current)

D. COURSE APPLICATION DETAILS

Course applying for: *

Mode of Study *

Level *

Faculty/Department *

Enrollment Date (Intake)

Course Duration

Lecture Session (Time)

E. APPLICANT DECLARATION

I hereby certify that all information on this form or any material attached in support thereof are true, correct and complete to the best of my knowledge and that all the information required has been disclosed accordingly.

Name *

Date *

Signature *

Message