MKU/ADR/F002/A

ADMISSION FORM

READ THE INSTRUCTIONS BEFORE COMPLETING THIS FORM.

TO BE FILLED BY KUCCPS STUDENTS ONLY
COMPLETE ALL APPROPRIATE SECTIONS IN CAPITAL/BLOCK LETTERS AND RETURN DURING REGISTRATION TOGETHER
WITH YOUR
OTHER SUPPORTING DOCUMENTS
PLEASE WRITE IN CAPITAL LETTERS.
1. STUDENTS DETAILS
FULL NAMES
(as per secondary school
certificates or its equivalent)
KCSE Index Number
TITLE MR [ ] MRS [ ] MS [ GENDER Male [ ] Female [ ]
]

DATE OF NATIONALITY. NATIONAL ID/PASSPORT

BIRTH NO.
COUNTY SUB- COUNTY LOCATION
2. PERMANENT ADDRESS
P.O.BOX EMAIL
MOBILE TOWN
PHONE
3. PARENT/GUARDIAN INFORMATION
NAME OF THE FATHER: PHONE NUMBER: OCCUPATION: DECEASED/ALIVE

NAME OF THE MOTHER: PHONE NUMBER: OCCUPATION: DECEASED/ALIVE

NAME OF THE GUARDIAN: PHONE NUMBER: OCCUPATION:

4. EMERGENCY CONTACTS
NAME: PHONE NUMBER: OCCUPATION: RELATIONSHIP

NAME: PHONE NUMBER: OCCUPATION: RELATIONSHIP

5. EDUCATIONAL BACKGROUND:
SECONDARY SCHOOL FROM (YEAR) TO (YEAR) CERTIFICATE AWARDED MEAN GRADE
ATTENDED

6. EDUCATIONAL PLANS (tick appropriate)

i. PROGRAMME
PLACED
 MKU/ADR/F002/A
ii. Teaching Subjects
/Specialization
(where possible)
iii. MODE OF STUDY REGULAR
iv. INTAKE PLACED January[] May[] September[ ]
7. CAMPUS WHERE STUDY WILL BE UNDERTAKEN (Tick appropriately).—MAIN [ ] NAKURU [ ] NAIROBI [ ]
8. FINANCING OF STUDIES.
Please Tick []SELF []PARENTS/GUARDIAN []GOVERNMENT/HELB []OTHER SPONSORSHIP
8. PREFERRED HOBBY
PREFERRED
SPORT
9. STATE WHETHER YOU HAVE ANY SPECIAL NEEDS THAT REQUIRE SPECIAL ATTENTION
Please Tick Yes [] No []
If yes, State the need: ……………………………………………………………………………………………..
10. INDICATE HOW YOU LEARNT ABOUT MOUNT KENYA UNIVERSITY
Radio [ ] Television [ ] Newspapers [ ] Friends [ ] Career Exhibitions [ ] KUCCPS [ ]Others State ………………………
11. ATTESTATION.
I hereby certify that the information given in this application is correct and complete to the best of my knowledge, and hereby give
my permission to the admissions office to obtain any verification deemed necessary. I further certify that I will arrange for the
forwarding of official transcripts as requested in the instructions, and that transcripts become the property of Mount Kenya University
and will neither be forwarded to another institution nor returned to me.

Signature : …………………………………………………… Date.: ………………………………………

SIGN YOUR APPLICATION FORM BEFORE RETURNING IT TO MOUNT KENYA UNIVERSITY.

REGISTRATION
Students should be registered for classes prior to the beginning of any semester to avoid irregularity of failure to attend
2/3 class attendance. As a new student, you will have time to meet with the Registrar Academic Affairs and complete
registration procedures during the registration/orientation period.
ONLY DULY FILLED ADMISSION FORM WILL BE ACCEPTED.
FOR OFFICIAL USE ONLY

NAME: ……………………………………………………………. SIGNATURE ………………………..DATE: …………………… STAMP……………

More information may be obtained from the Office of Registrar, Academic Affairs Mount Kenya University
www.mku.ac.ke