Directorate of Career Development &

Mentoring Programme
P. O. Box 43844-00100 NAIROBI, Tel. 8710901, 020 2310717/0736631087, Email: careers@ku.ac.ke
Committed to providing earnest support and diligent service to prospective and continuing students as well as
The alumni of Kenyatta University in career guidance and counselling, career development and employment education
KENYATTA
UNIVERSITY

CONSENT FORM (CDMP FORM A)

This form is to be completed and a copy sent (ASAP) to the Attachment and Practicum Office
(above address) and the attachment co-ordinator of your department to certify that our student has been
accepted and began her/his attachment with the relevant organization/institution. The form will also help
our office arrange for the field supervision of the student.

This to certify that Mr./Ms…………………………………………………………………………...

Registration Number………………………………………………………………………………….

School of ............................................................................................................................................

Has been accepted and began his/her attachment on………………………………………………….

and is expected to complete the attachment on……………………………………………………….

Name of Organization: ………………………………………………………………………………..

Department/Section: …………………………………………………………………………………..

Name of Supervisor: ……………………………………………..Telephone No.……………………

Postal Address: ………………………………………………………………………………………..

Physical Address: ……………………………………………………………………………………..

Telephone Number(s): ………………………………………………………………………………..

Email address: …………………………………………………………………………………………..

Student’s Cell phone Number: ………………………………………………………………………..

Any other helpful information: ……………………………………………………………………….

………………………………………………………………………………………………………..

Name of the Officer in Charge: ………………………………………………………………………

Title: ................................................................................ Telephone No.............................................

Signature/Stamp: ………………………………………………….Date:……………………………

www.ku.ac.ke careers@ku.ac.ke

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