Jomo Kenyatta Application Form – Fill Out and Use This PDF

STUDENT APPLICATION/REGISTRATION FORM

(CERTIFICATE/DIPLOMA COURSES)

(To be filled in duplicate)

Surname: _____________________________ Gender (M/F) ______________________

Other Names: ____________________________________________________________

Company: _______________________________________________________________

Address: ________________________________________________________________

Telephone: ______________________________________________________________

E-mail: _________________________________________________________________

Date of Birth: ____________________________________________________________

ID/Passport No: __________________________________________________________

Indicate the course applied for:

Certificate in Information Technology

Diploma in Information Technology

Diploma in Computer Technology

Certificate in Management and Information Technology

Diploma in Management and Information Technology

Certificate in Purchasing and supplies Management

Diploma in Purchasing and supplies Management

Diploma in Business Information Technology

Diploma in Business Administration

Diploma in Public Relations, Advertising & Sales

Diploma in Mass Communication

Diploma in Mechanical Engineering

Diploma in Electrical/Electronic Engineering

Diploma in Clinical Medicine

Certificate in HIV/AIDS Management

Diploma in HIV/AIDS Management

Diploma in Human Resource Management

Diploma in Community Development

Diploma in Microfinance

Bridging Course in Information Technology

Intake Date: _____________________________________________________________

Centre of Study: __________________________________________________________

EDUCATION

Schools Attended	Dates – From (year) to (year)	Qualification

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NB: (Attach to each form Certified Copies of the relevant Certificates, Result slips, National Identity Card, Birth Certificate and two Recent Passport Size Photographs)

Sponsorship Self:

Others (parent, Organization): _______________________ Address: ______________________

Telephone: _________________________________ Contact Person: ______________________

Name and Address of the nearest relative, person or agency to be contacted incase of emergency;

Name: ________________________________________ Relationship: _____________________

Address: ______________________________________________________________________

Telephone: _____________________________________________________________________

TERMS AND CONDITIONS

1.Course fees must be paid in advance at the time of booking, unless prior credit arrangements are made and approved by an authorized officer of the Company.

2.Where credit is granted, the account must be settled within the agreed period otherwise a monthly penalty charge of 3% will be levied on a cumulative basis.

3.A 20% fee will be charged for any bookings cancelled or abandon of classes.

4.There will be no refund for any bookings cancelled or abandonment of classes once they have commenced.

5.A Ksh. 1,000 service fee will be charged on all returned cheques.

6.The center accepts no liability for loss or damage to any property brought or left on the premises by students.

7.Students will be charged for any damages caused to equipment by their negligence.

8.Certificates will only be awarded after fulfillment of all the particular course’s requirements.

I certify that the information/statements made by me on this form are correct and complete. I further certify that I have read, understood and agreed to comply with the terms stipulated herein.

Signature: ___________________________________ Date: _____________________________

SPONSOR’S UNDERTAKING

We, the undersigned, hereby confirm that the applicant will be sponsored by ourselves for the listed courses. Please bill us. Payment will be made within ______________ days.

Name of Sponsor: ___________________________ Authorised Signature: _________________

Date: _________________________________________________________________________

All correspondences should be addressed to:-

The Head of Institution where the Application forms are obtained.

FOR OFFICIAL USE ONLY

Sign: _____________________________ Date: _______________________________________

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