THE NYERI NATIONAL POLYTECHNIC

P.O. Box 465-10100 Tel: 061-2032330 Fax: 061-2032852 Mobile: 0724-477942

Website: www.thenyeripoly.ac.ke E-mail: info@thenyeripoly.ac.ke

NNP/ REG /ADM/APPLICATION FORM

APPLICANT’S DETAILS
SURNAME_________________ FIRST NAME____________________ MIDDLE NAME____________________

DATE OF BIRTH (DD/MM/YY) ____________ GENDER _________ TEL: ______________________________

ID /PASSPORT NUMBER HOME ADDRESS: ____________________

NATIONALITY ______________ E-MAIL ______________________________ DATE _________________

KCPE INDEX NO YEAR KCSE INDEX NO YEAR

EDUCATION DETAILS
COURSE APPLIED FOR ____________________________________________________________________

LAST SCHOOL ATTENDED _______________________________________YEAR______________________

MEAN GRADE ATTAINED ____________________________________________________

ENGLISH/KISW ___________________________________________________

MATHS _________________________________________________________

PHYSICS _________________________________________________________

CHEMISTRY/PHYSICAL SCIENCE ___________________________________

BIOLOGY/BIOLOGICAL SCIENCE ___________________________________

OTHER QUALIFICATIONS_____________________________________________________

PARENT’S/GUARDIAN’S DETAILS

SURNAME_________________ FIRST NAME______________________ MIDDLE NAME_____________________

P.O. Box _________________ POSTAL CODE TOWN _________________

TELEPHONE: FAX:

MOBILE:

E-MAIL _____________________________________________________

NOTE: ATTACH PHOTOCOPIES OF: KCPE CERTIFICATE, KCSE CERTIFICATE/RESULT SLIP, ID CARD, LEAVING CERTIFICATE
AND BIRTH CERTIFICATE.

OFFICIAL USE

Candidate qualified for the Course Yes No

HOD’s Comments __________________________________________________________________________