RVIST/QMS/REG/F/19

RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY

RVIST ISO 9001:2015 QUALITY MANAGEMENT SYSTEM DOCUMENT

LETTER OF ACCEPTANCE AND DECLARATION BY THE APPLICANT

Dear Sir,
Applicant’s Surname/Last Name
Applicant’s Other Names
ID Number
Birth Certificate Number
Admission Letter Reference No
:________________________________________
:________________________________________
:_______________________________________
:________________________________________
:_________________________________________

With reference to your letter offering a vacany in:

Course Name __________________________________________________
This is to confirm that I DO ACCEPT the offer and I PROMISE TO ABIDE by the rules and regulations gov-
erning the conduct and discipline of the students of RVIST

I do hereby undertake to COMPLETE THE COURSE for which I have been accepted WITHIN THE STIPU-
LATED DURATION unless I am discontinued by the Institute Management

I will accept the Rules and Regulations made from time to time for the good order and governance of the Insti-
tute.

I accept ANY DISCIPLINARY CONSEQUENCES at any stage of my application, admission or studentship

in the event tat the information provided in the application or admission form is found to be false.

Yours faithfully,

Signature of the Applicant___________________ Date:_____________________

 RVIST/QMS/REG/F/11

RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY

ISO 9001:2015 QUALITY MANAGEMENT SYSTEM

CERTIFICATE OF MEDICAL EXAMINATION

STUDENT DETAILS

Name: _________________________________________

ID No: _________________________________________

Course: _________________________________________

MEDICAL REPORT:

a) Vision: _______________________________________________________________________
b) Hearing: ______________________________________________________________________
c) Physical Handicaps (if any): _______________________________________________________
d) Any previous major illness e.g.: _____________________________________________________
Epilepsy_______________________________________________________________________
Hypertension____________________________________________________________________
Asthma_________________________________________________________________________
Ulcers__________________________________________________________________________
Any communicable diseases_________________________________________________________
e) Allergies to food/chemical etc. _____________________________________________________
f) Any condition that may not allow the trainee to undertake the course _________________________
______________________________________________________________________________

CERTIFICATION

The candidate named has been examined and I can/cannot certify that she/he is medically fit to pursue the
course.

Doctor’s name: ___________________________________

Address: ________________________________________

Signature: _______________________________________

Date: _______________________________________

(Official Stamp)

Revision 1
 RVIST/QMS/REG/F/10

RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY

RVIST ISO 9001:2015 QUALITY MANAGEMENT SYSTEM DOCUMENT

STUDENT PARTICULARS FORM

Name(as per the results slip)________________________________________ ID Number_________________
Date of Birth (dd/mm/yyyy)_________________________________ Gender: Male Female
Birth Certificate Number:__________________ NEMIS Number:___________________
Marital Status: Single Married
If married (Spouse’s) Name____________________ Mobile Number____________________
CONTACT DETAILS
P. O. Box ___________Postal Code __________ Town ______________Mobile No_____________________
County___________________ Sub-county______________________ Location_______________________
Sub-location_____________________ Village/Estate________________________

Mother’s Name____________________ Alive Deceased

P. O. Box ___________Postal Code __________ Town _________________Mobile No_____________________

Father’s Name____________________ Alive Deceased

P. O. Box ___________Postal Code __________ Town _________________Mobile No_____________________

Guardian’s Name____________________ (any person who can be contacted in case of a problem)

Relationship____________________________
P. O. Box ___________Postal Code _________ Town _______________Mobile No_____________________

ACADEMIC DETAILS
GRADE/
LEVEL SCHOOL/INSTITUTION NAME INDEX NUMBER YEAR
POINTS
PRIMARY

SECONDARY

ARTISAN

CRAFT/
CERTIFICATE

Responsibilities held in former school___________________________________________________

Extracurricular activities participated_____________________________________________________
WORK EXPERIENCE

Organization Address Position Held

DECLARATION
I ________________________________________________ of ID Number________________________
hereby declare that I have read and understood the institutes rules and regulations. I will undertake to abide
by them at all times at every level of the Institute administration and if go against them o accept any discipli-
nary measures taken against me.

I also declare that the information I have given above and all documents attached in support of this admission
are all valid and correct
Signed ______________________________ Date_________________________________
Student

Parent/Guardian’s Name___________________________________ ID No_____________________

Signed_________________________ Date______________________________________
 RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY
P O BOX 7182-20100, NAKURU
TELEPHONE 0720668238
Email: principal@rvist.ac.ke

ADDITIONAL INFORMATION
COLLEGE RULES AND REGULATIONS AND ACADEMIC POLICY:
All students are expected to download, read, understand and obey the rules and regulations and to
sign the declaration contained in the student’s particulars form and the guardian to countersign,
confirm and affirm commitment to abide by the college rules and regulations. The medical form
attached must be filled properly in a recognized Government hospital.

GAMES KITS:
All students should bring a pair of rubber shoes. In addition, the men should bring a red T-shirt
and a red pair of shorts. The ladies should bring light blue T-shirt, bloomers and wraparound.

BOARDING FACILITIES:
Hostels are allocated on First-come-first served basis, only if one has cleared the fees.

PERSONAL EFFECTS:
All students should bring their own personal effects including two blankets, two bed sheets, pillow
case, towel, toiletries, ordinary leather shoes, adequate clothing, cutlery and utensils and
basin/bucket for storing water.

LUNCH:
Lunch is provided to day scholars on payment of the stipulated lunch fee.