SCHOOL OF PROFESSIONAL PROGRAMMES COURSE APPLICATION FORM

Complete all appropriate sections in block letters and return with your non-refundable application fee, copies and originals of
your certificates and other supporting documents to: Office of the Registrar, KCA University, P. O. BOX 56808-00200,
NAIROBI KENYA. TEL: +254715532187 / +254792793056 / +254710888022 / +254734888022 / 020 8070408/9 /FAX: 254-
020-8561077
E-mail: [email protected] Website: www.kca.ac.ke AFFIX 2
RECENT

PASSPORT

PHOTOS

Applicant’s Name(s)
Surname First Middle

Month / Date / Year

Date of Birth: / / Female Male Religion:
Place of Birth: Citizenship: Marital Status:
Single Married
National ID No / Passport No: Residential District: Home Location:

Mailing Address/ Contacts

P.O. Box / Postal Code / Town Mobile No(s). Tel No. (office/house) Email Address
a)
/ / b)

Next of Kin or Guardian’s Details (Contacts in case of emergency)

Name ………………………………………………… Relationship to applicant………………………………

P.O. Box ……………........ Postal Code …………… Town……………….……………………………………
Telephone...…………………………………………… Email address…….……………………………………..

Course Name (Tick where appropriate)

CPA (Certified Public Accountant) ICDL (International Computer Driving License)
CPS (Certified Secretaries) CISCO /CCNA
ATC (Accounting Technician Diploma) Computer Packages
ACCA (Association of Certified Chartered Linux
Accountants)
CIFA (Certified Investment & Financial
Analysts)

Preferred Intake Year: …………. Mode of Study

January July Full time Part time Weekend

Guarantee of Fee Payment (tick where appropriate)

Campus: Main/Ruaraka City Centre/Town Kisumu
Guarantee of Fee Payment (tick where appropriate)
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Parent Guardian Self Sponsor Employer

Contacts (Tel/Mobile)................................................

Have you previously registered with KCA?

Yes No If yes, gives your KCA Reg. Number

Education (please list last secondary school and colleges attended)

Name Period attended

Level attained
(School/College) From To Course/Education (e.g. certificate, Grade/A
diploma, degree) ward
Secondary/High School
a).
College/University
a).

b).

Current Employer Details

Company Name Position (Title)

Work Experience Address
(Duration)
……………………………… ………………………… ……….………………… ………................................

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 achievements: Extra Curricular Activities:

Community Involvement: Corporate Awards (achievement on exemplary job performance):

Relatives who have attended KCAU (if any)

Name ……………………………………Relationship ………………….. Mobile No. ……………………

Name ……………………………………Relationship ………………….. Mobile No. ……………………

How did you learn about KCA – Tick one

College Guide Newspaper TV Radio KCAU Website

Exhibition Parent Relative Friend School Teacher

KCAU Student KCAU faculty Mailing College/High School Fair KCAU alumnus/alumni

Other (specify) …............………

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 Please indicate your sport and club of choice (tick your option/s)

Sport Clubs

Athletics Rugby First Aid Club Accounting Students Association

Basketball Soccer Forum for IT Students Christian Union (CU)

Hockey Volleyball Presidential Award Catholic Association (CU)

Tennis Wildlife Club Seventh Day Adventist (SDA)

Other (Specify)............................................. Entrepreneurship Club Peer Councillors Club

Students Initiative Against AIDS and Substance Abuse (SIAASA)

Other (Specify)..........................................................................

• All forms MUST be SIGNED before returning them to the Admissions Office. ORIGINALS and
COPIES of the following documents must be attached;

1. National ID /Birth Certificate

2. O’ level Certificate/Result slip
3. Academic Transcripts FOR OFFICIAL USE
4. Two colour passport-size photographs

• Application fees (Kshs 1000) can be deposited in one of the following KCAU bank accounts: Certified & Processed

Bank Code Account No . Bank Name

Officer: ……………
- 002 010 200 117 1100 Standard Chartered Bank-Ruaraka,
- 073 135 217 8 Barclays Bank – Westlands,
- 075 176 631 9 Barclays Bank –Moi Avenue, Sign: ………………
- 007 107 654 003 Commercial Bank of Africa – Wabera Street
Date: ………………
• ORIGINAL DEPOSIT SLIP must be attached to the application form when submitting to the
admissions office
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 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: .…………………………

Thank you for choosing to study with us!

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