REF: F2-59-9-1

Affix a recent
REF: F2-59-9-1 S/NO……………………….
Photograph
Receipt NO.…
Here

JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY

KAREN CAMPUS

JANUARY 2023 ADMISSIONS

APPLICATION FOR DIPLOMA IN……………………………………………………………………….

Surname……………………………………………………………………..Title: (Mr./Ms)……………………………………………...

Other names……………………………………………………………………..Gender (M/F)…………………………………………...

Name of parent or guardian………………………………………………………………………………………………………………...

Permanent address………………………………………………………………………………………………………………………….

Contact address……………………………………………………………………………………………………………………………..

Telephone……………………………………………………………….Fax………………………………………………………………

Email…………………………………………………………………Nationality…………………………………………………………

Date of Birth……………………………………………………………I/D/Passport No…………………………………………………

EDUCATION / TRAINING
DATES CERTIFICATES
INSTITUTIONS ATTENDED From (year) To (year)

Have you ever been expelled or discontinued from another Institution of higher learning?
If yes please attach details.

NB: Attach copies of the relevant certificates, one recent passport size photograph, National ID Copy/Birth certificate Copy and
Application fee receipt copy.

Page 1 of 2

JKUAT is ISO 9001:2015 and 1SO 14001:2015 Certified

Setting trends in Higher Education, Research, Innovation and Entrepreneurship
How did you learn about JKUAT Karen Campus?

Referral Website Social media Mass media advert Others

……………………………………………………………………………………………………………………………

SPONSORSHIP

Sponsor (Self, Parent, Organization), Write the name………………………………………………………………………………………………...

Address of sponsor…………………………………………………………Telephone……………………………………………………

Email…………………………………………………………………………Fax…………………………………………………………

TERMS AND CONDITIONS

1. The courses will only be conducted if the University Senate approved quorum is realized.
2. Fees must be paid in advance or on the opening date.
3. A 20% will be charged on any booking cancelled before commencement of classes.
4. A Kshs 2,000 service fee will be charged on all returned cheques.
5. JKUAT accepts no liability for loss or damage to any property brought or left on the premises by students
6. The JKUAT does not accept any liability whatsoever for any injuries incurred during training.
7. Students will be charged for any damage caused to equipment.
8. Students will not be allowed to change from one Course to another once the short listing is complete.
9. Incomplete applications will not be honoured.

DECLARATION

I... …………………………………………………………………….declare that the information given in this application

form is correct. I further certify that I have read, understood and agreed to comply with the terms stipulated herein.

Sign…………………………………………………….. Date…………………………………………

Page 2 of 2

JKUAT is ISO 9001:2015 and 1SO 14001:2015 Certified

Setting trends in Higher Education, Research, Innovation and Entrepreneurship