EU/AA/FM/02B
EGERTON UNIVERSITY
Tel: +254-51-2217802
P.O. Box 536 – 20115,
Fax: +254-51-2217827
EGERTON, Kenya.
E-mail: [email protected]
www.egerton.ac.ke Affix
Current
OFFICE OF THE REGISTRAR PassportPhoto
(ACADEMIC AFFAIRS) Here
APPLICATION FORM FOR SELF-SPONSORED/ IN-SERVICE UNDERGRADUATE DEGREE OR
/ SELF-SPONSORED/ REGULAR DIPLOMA PROGRAMMES (tick as appropriate)
NOTES:
a) This form should be completed and returned to the REGISTRAR (ACADEMIC AFFAIRS), EGERTON UNIVERSITY,
P.O. BOX 536-20115, EGERTON, on or before the closing date as advertised.
b) Sections A, B, C and D of this form should be completed in Block Letters.
Ensure that you attach the Following;
c) Certified copies of your Result Slip, Certificates and Transcripts.
d) ORIGINAL RECEIPT (Application Fee): KShs. 2,000 for ALL Degree Programmes and Kshs. 1,000 for all
Undergraduate Diploma Programmes: Payable to; Account Name; Egerton University, Kenya Commercial Bank;
Account No: 1108550703.
e) Copy of your National ID Card or Birth Certificate.
SECTION A: PERSONAL DATA
Name: ……………………………………………………………………………………………….
(Surname) (Other names in full)
Date of Birth: ……………………….Sex: ……………. Marital Status: …………………Religion: …….………………………..
Nationality ID/Passport No
County Phone No
District P.O. Box
Constituency Town
Email address Postal Code
SECTION B: ACADEMIC HISTORY
a) Secondary School Attended Year Grade
Other Relevant Qualifications
b) Institution Attended Year Qualification/Award
c) State any relevant academic/professional qualifications or experience
……………….........................................................................................................................................................
Egerton University is ISO 9001:2008 Certified
EU/AA/FM/02B
SECTION C: CHOICE OF COURSES
State the course(s) for which you wish to be considered for admission.
State whether you are applying for Degree/Diploma: ______________________________________________________________________________
Mode of Study (Self- Fulltime/
Write below, the title of the Course(s) you are applying for; sponsored/ Inservice/ Part-time
Regular)
First:
Second:
Preferred Campus (Njoro, Nakuru Town, A.I.C.O, K.I.P.C. Nairobi/Nakuru/Kisumu):_______________________________________
a) Have you ever been admitted to Egerton University previously (YES/NO)? ___________
If YES, indicate the previous Registration number…………………………………………………………………………………
Give reasons for applying afresh…………………………………………………………………………………………………………………………..
Indicate how you intend to finance your studies………………………………………………………………………………………………….
SECTION D: DECLARATION
I certify that the information given in this application form is correct to the best of my knowledge
Sign…………………………………………………………..Date………………………………………..
b) Name of Employer (if any)………………………………………………………………………………………………………………………………..
Recommendation …………………………………………………………………………………………………………………………………………….
Designation…………………………………………………………………………………Sign……………………………………………………………..
Official Stamp
SECTION E: FOR OFFICIAL USE ONLY
a) Recommendation of the Head of Department (Recommended/Not Recommended)
Comments……………………………………………………………………………………………………………………………………………………….
Sign……………………………………………………………………………………………………..Date……………………………………………………
Official stamp
b) Recommendation of the Dean of Faculty (Recommended/Not Recommended)
Comments………………………………………………………………………………………………………………………………………………………..
Sign……………………………………………………………………………………………………..Date……………………………………………………
Official stamp
c) Recommendation of the Deans Committee (Recommended/Not Recommended)
Comments………………………………………………………………………………………………………………………………………………………..
Sign……………………………………………………………………………………………………..Date……………………………………………………
Official stamp
d) Approval by Registrar (AA)
Sign……………………………………………………………………………………………………..Date……………………………………………………
Egerton University is ISO 9001:2008 Certified
