KENYATTA UNIVERSITY

OFFICE OF THE REGISTRAR (ACADEMIC)

APPLICATION FORM FOR ADMISSION INTO THE

CERTIFICATE COURSES.
NOTES

(i) This form should be completed and returned to:

The Registrar (Academic), Kenyatta University, P.O. Box 43844,
NAIROBI.

(ii) The form should be typed or completed in BLOCK LETTERS.

(iii) Attach copies of (a) your current appointment letter,(where applicable),

(b) your professional and academic certificates and transcripts where
applicable and (c) copy of the receipt for the application form.

SECTION A

Name..
(Surname) (Other names in full)

Contact Address.

Name of School/Institution and address

...

Telephone No:Nearest Town:

Date of Birth: Day.. MonthYear...

Citizenship:.

Identity Card No. (For Kenyans):

Passport No. (For non-Kenyans)..

Sex:

Marital Status:

Religion:.
 SECTION B
10. (a) Name of certificate applied for....

(b) Institute ..

(c) School ..

(d) State whether Full-time or Part-time

11. Secondary Schools attended and Qualifications obtained

SCHOOLS ATTENDED ATTENDANCE QUALIFICATIONS OBTAINED
FROMTO..

12. (a) Other Qualifications:

COLLEGE FROM QUALIFICATION CLASSIFICATION SUBJECT(S) DATE
ATTENDED TO.. OBTAINED STUDIED AWARDED

(b) Working experience (where applicable)

EMPLOYER STATION OF WORK OCCUPATION FROM:
..TO:
..

SECTION C
To be completed by the Head of School/Institution where the applicant is currently working
(where applicable).

12. Name of the Head of School/Institution (where applicable):

Signature:..Date:.

School/
Institution stamp

Signed by the Applicant:.Date:.

SECTION D
13. For Official Use:

Approved/Not Approved for admission.

Signature:Date: