Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full NamesID NumberDate of BirthCitizenshipMarried? (If Yes, Provide Name and Contact of Spouse) YesNoName of SpouseContact of SpouseHome Address Institute Have the Email *Do You Have Any Disabilities?YesNoNature of DisabilityFather's Details (Names)OccupationPhone NumberMother's Details (Name)OccupationPhone NumberGuardian's Details (Name)OccupationPhone NumberAss. Chief (Name)ContactChief (Name)ContactWho Pays Your Fees? (Name)RelationshipContactCo-curricular Activitiies of Your Interests?Activity 2Activity 3Do You Suffer from any Chronic Ailments? If Yes, State the AilmentYesNoIf Yes, State the AilmentHave you ever been convicted? If Yes, State the Nature of the OffenceYesNoIf Yes, State the Nature of the OffencePrimary School Attended (Name)Full K.C.P.E Index No. (Include School Code)Start YearEnd YearExamination YearSecondary School Attended (Name)Full K.C.S.E Index No. (Include School Code)Start YearEnd YearExamination YearAre You Placed By KUCCPS? If Yes, State the InstituteYesNoIf Yes, State the InstituteSubjects Taken in the Last Examination and Grades (Subject)GradeSubjectGradeSubjectGradeSubjectGradeMean-GradeCourse Applied ForI certify that all the information given in this form is true and correct to the best of my knowledge and beliefCorrectSubmit
