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UNDERGRADUATE COURSE APPLICATION FORM


COMPLETE ALL APPROPRIATE SECTIONS IN BLOCK LETTERS AND RETURN WITH YOUR NON-
REFUNDABLE APPLICATION FEE (see application requirements below)
AND OTHER SUPPORTING DOCUMENTS TO:
KCA UNIVERSITY
OFFICE OF THE REGISTRAR
P.O BOX 56808-00200
NAIROBI
KENYA.

TEL: 254-020 8561045/6177/803/8
FAX: 254-020-8561077
E-mail: registrar@kca.ac.ke
Website: www.kca.ac.ke

Applicants Name(s)
Surname First Middle


Personal Information
Date of Birth Month Day Year

Female Male
Place of Birth Citizenship Marital Status
National ID No / Passport No Residential District. Home Location
Religion Email Address


Contact Address
P.O Box Number Town
Postal Code Mobile No
E-mail Address Tel No

Next of Kin or Guardians Details (Contact in case of emergency)
Name Relationship to applicant
Address Telephone..
Fax ... Email address..

Guarantee of Fee Payment; Guardian

Parent Self Sponsor Employer



Contacts (Tel/Mobile).

Course Name
Bachelor of Commerce Bachelor of Science in I.T

Others (Specify).

Preferred Intake

J anuary 2011 May 2011 September 2011

Mode of Study Day Evening Weekend


AFFIX 2 RECENT

PASSPORT

PHOTOGRAPHS
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Education
Please List last secondary school and Colleges attended
Name Period attended Grade Certificate diploma or degree awarded
From To
School

Colleges



List any academic honours and awards, non academic achievements such as sporting activities, community involvement and
/ or work experience over the last 10 years

Academic

Non Academic
(i) Community Involvement :
(ii) Extra Curricular activities :
(iii) Work Experience :

Please indicate your sport and club of choice

SPORT


CLUB (S)
Athletics Accounting Students Association (ASA)
Basketball Forum For IT Students (FIT)
Hockey Students Initiative Against AIDS and Substance abuse (SIAASA)
Rugby Presidential Award
Soccer Wildlife Club
Volleyball C. U C.A S.D.A
Tennis First Aid Club
Other (specify) Peer Councillors Club

Entrepreneurship Club



How did you learn about KCA Tick one

College Guide Newspaper TV Radio Mailing College/High School Fair KCAU Website

Exhibition Parent Relative KCAU student KCAU faculty KCAU alumnus/alumna Friend


School Teacher Other (specify) .




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Current Employer Details

Company Name Position (Title) Duration of Employment

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ATTESTATION
















Note.
All forms must be signed before returning them to the Admissions Office. Certified copies of the following documents
must be attached;
1. Birth Certificate/National ID
2. Olevel certificate/Result slip
3. Academic transcripts
4. Two colour passport-size photographs


Application fees (Kshs 1000) can be deposited in one of the following KCAU bank account numbers: 0102001171100
Standard Chartered Bank-Ruaraka, 135-217-8 Barclays Bank Westlands, 176-631-9 Barclays Bank Moi Avenue or
107-654-003 Commercial Bank of Africa Wabera Street

Original deposit slip must be attached to the application form
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 to process my
application. I further certify that attached are true copies of my official transcripts as requested, and that the copies
become the property of the university. I include with this application form the official payment receipt /Bank deposit slip
for the application fee and copies of other documents as stated in the application requirements.

Signature. . Date...