Kiriri Women's University of Science and Technology

ONLINE APPLICATION FORM

PERSONAL INFORMATION ( USE BLOCK LETTERS)
Title Miss/Ms/Mrs/Other
Surname/Family Name
First Name
Middle Name
Marital Status
Date of Birth
Place of Birth
Citizenship
PERMANENT HOME ADDRESS
P.O. Box Number
Postal Code
City/ Town
Telephone Number
Fax Number
Email
CURRENT MAILING ADDRESS ( IF DIFFERENT FROM ABOVE)
P.O. Box Number
Postal Code
City/ Town
Telephone Number
Fax Number
Email
NEXT OF KIN
Name
Relationship to Applicant
Address
Telephone
Fax
Email

DEGREE OF STUDY
What degree are you applying for ?
Do you require accomodation?		Yes		No
Do you require transport?		Yes		No
Accomodation and transport will be offered at an extra fee

ENROLLMENT INFORMATION
Please list all educational/ training institutions previously attended
KCSE/GCE/IGSCE results (tick exam taken)
Year Exams was taken
Score / Grade
Subject		Grade Obtained










College	Type of Education	Mo/Yr to Mo/Yr	Area of Study	Names of Certificate Awarded





Activities and / or Work Experience

Please list your Academic Honors, Awards, Community Involvement and Scholarships.
How did you learn about KWUST. (Tick as appropriate).		College / High School Fair University Directory Others / Specify		Newspaper Radio TV Internet
Rank numerically the three people who influenced you to apply to KWUST		Parent KWUST Faculty KWUST Admission Representative KWUST Alumnus/ Alumna Others / Specify		KWUST Student Friend School Teacher School Counselor
Why did you select KWUST for your studies?
MEDICAL CONDITION
Please list any medical condition(s) or disabilities may affect your studies e.g physical disability e.t.c

AFFIRMATION
I hereby affirm 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 Committee to obtain any verification deemed necessary to process my application.

P.O. BOX 49274 - 00100
Nairobi, Kenya

Westlands Campus Telephone : 254 - 2 -4442212

Kasarani Campus Telephone : 2042692/3 Mobile : 0723 338071 / 0736 329642
Fax : 4444175