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MOI UNIVERSITY Pssp Application Forms

MOI UNIVERSITY Pssp Application Forms

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Published by Denley Kim
MOI UNIVERSITY PRIVATE SPONSORED STUDENTS APPLICATION FORM
MOI UNIVERSITY PRIVATE SPONSORED STUDENTS APPLICATION FORM

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Published by: Denley Kim on Jun 08, 2013
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11/15/2013

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REF: MU/PSSP/AF/01/98OFFICIAL USE ONLYReceipt No. _________ Serial No. __________ 
MOI UNIVERSITY
PRIVATELY SPONSORED STUDENTS PROGRAMME (PSSP)
 APPLICATION FOR ADMISSION
SCHOOL/INSTITUTE OF …………………………………………………………………………I PERSONAL DATA
1. Applicant’s Name: ….…………………………………………………………………………….
(Surname First Name Middle Name)
2. Contact (Postal Address): …………………………………………………………………..Tel./Mobile No. …………………………………………………………………………….…E-mail: ………………………………………………………………………………………...3. Date of Birth: ………………………….… ID/Passport No.………………...…...…………4. Nationality: …………………………..……………………………………………………..5. Gender: Male Female
(Tick as appropriate)
 6. Physically OR Visually Challenged None
(Tick as appropriate)
 Address …………………………………….... Tel. No. ……………………….………….…7. Next of Kin:…………………………………….. Relationship ……………………………(Name)Address …………………………………………….Tel/No………………………………………..
II PROGRAMME APPLIED FOR:Degree Diploma Certificate
(Tick as appropriate)
Indicate the specific programme e.g. B.Sc. in Media Science or Diploma in Religious Studiesetc.……………………………………………………………………………
III ACADEMIC YEAR
……………………………………………………………………………(e.g. 2012/2013)
IV CAMPUS
………………………...……………………………………………………………..
V MODE OF STUDY:
Fulltime EveningWeekend Holidays Short Duration
(Tick as appropriate)
VI RECORD OF SECONDARY EDUCATION
(Attach Certified copies of Result Slips andCertificates
SCHOOL FROM(YEAR) TO(YEAR) CERTIFICATE GRADE

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