UNITED STATES INTERNATIONAL UNIVERSITY - AFRICA

READ THE APPLICATION INSTRUCTIONS BEFORE COMPLETING THIS FORM

COMPLETE ALL APPROPRIATE SECTIONS IN CAPITAL/BLOCK LETTERS AND RETURN WITH YOUR
NON-REFUNDABLE APPLICATION FEE (see Fee Schedule) AND OTHER SUPPORTING DOCUMENTS

TO:
USIU - AFRICA AFFIX RECENT
Admissions Office
P.O. Box 14634-00800 PASSPORT
NAIROBI
KENYA PHOTOGRAPH

Tel: 0730 116 000/218/503/247/522

E-mail: [email protected]
www.usiu.ac.ke

q Mr. Last First Middle

q Mrs.
q Ms.

Other Name(s)/Maiden name, if any

Permanent Address

Street Address P.O. Box Number

City/Town State/County/Province

Zip/Postal Country

Cell Phone E-mail

Current Mailing Address (if different from above)

Street Address P.O. Box Number

City/Town State/County/Province

Zip/Postal Country

Personal Information
Date of Birth Month Day Year Female q Male q
Place of Birth Citizenship Marital Status

Social Security No./National ID No. Passport No. Permanent US resident YES q NO q

Are you a permanent Kenyan resident or citizen? YES q NO q

If YES, provide a copy of this status together with the application and state your province of birth
If NO, complete and return Pupil’s Pass forms and a letter from your sponsor guaranteeing all payments

Father’s/Mother’s Details (Indicate Emergency contact in Nairobi if any.)

Name Address Town

Telephone Email

Next of Kin details

Name Address Town

Telephone Email
USIU-AFRICA - REG./A
 ENROLMENT INFORMATION
Please tick your preferred semester of enrolment

Fall Spring Summer Year

(September) q (January) q (May) q

Degree

Bachelor’s q Master’s q Doctoral q

Major

Concentration / Minor

Have you previously applied to USIU-Africa? Past USIU-Africa Student ID Number?

YES q NO q

Admission into our graduate Counseling Pyschology and International Relations Programs will only be done during
Fall (September) Semester. M.A. Communication Studies and MSc. Information Systems & Technology will only be
done during Spring (January) Semester; whereas B. Pharmacy will only be done in Summer (May) Semester.

Given the very limited housing space available on campus, should you wish to use on-campus housing, you MUST
complete the Housing Application Forms and confirm availability of space.

EDUCATION
PLEASE LIST ALL SCHOOLS AND COLLEGES ATTENDED IN THE FOLLOWING SECTION, ATTACH AN EXTRA PAGE, IF NECESSARY

PERIOD No. of NAME OF CERTIFICATES/

NAME OF SCHOOL/COLLEGE/ UNIVERSITY CITY, STATE COUNTRY ATTENDED YEARS DIPLOMAS OR DEGREES
MO/YR MO/YR SPENT AWARDED

to

to

to

PLEASE LIST YOUR ACADEMIC HONORS, AWARDS, COMMUNITY INVOLVEMENT, SCHOLARSHIPS, ACTIVITIES AND/OR WORK EXPERIENCE

PLEASE INDICATE YOUR SPORTS AND CLUBS PARTICIPATION BELOW

SPORT PLEASE INDICATE THE CLUBS YOU PARTICIPATED

LEVEL IN WHILE IN HIGH SCHOOL
(National, Provincial, District, School)
q Athletics
1.
q Basketball
q Golf
q Hockey 2.
q Rugby
q Soccer
q Squash 3.
q Swimming
q Tennis
q Tae Kwondo
q Volleyball 4.
q Any other
(Specify)
Sponsor’s Details
Full Name:
Address:
Telephone:
E-mail:

Statistical Information
This information will be used for statistical purposes only and will in no way affect the admission decision. Completion of this
section is not mandatory, however, the data collected will help the University determine need in planning. Your providing this
information is appreciated.

Disabilities
None q Hearing q Mobility q Sight q Learning Disability q Other q

College Interests
Please list the first three colleges and universities into which you have applied:

1. 2. 3

How did you learn about USIU-Africa? Tick one

College Guide q Newspaper q T.V. q Radio q Mailing q College/High School Fair q USIU-Africa Website q

Exhibition q Parent q Relative q USIU-Africa student q USIU-Africa faculty q USIU-Africa alumnus/alumna q

Friendq USIU-Africa Admission Representative q School Teacher q Social Media (specify) q

Other (specify) q

Relatives/Parents who have attended USIU-Africa, if any

NAME RELATIONSHIP YEAR OF ATTENDANCE

NAME RELATIONSHIP YEAR OF ATTENDANCE

Have you visited the Campus? Have you met with an USIU-Africa Admissions Representative?

YES q NO q If YES, when? YES q NO q If YES, who?

Are you Employed? YES q NO q

If employed state:

COMPANY NAME POSITION (TITLE) DURATION

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 I will arrange for the forwarding of official transcripts as requested in the instructions, and that such transcripts
become the property of the university and will neither be forwarded to another institution nor returned to me.
I will include with this application my application fee and other documents as required in the application instructions.
Finally, I acknowledge that completing an application form does not guarantee admission.

Signature Date

IT IS MANDATORY TO SIGN YOUR APPLICATION FORM BEFORE RETURNING IT TO USIU-AFRICA

APPLICATION CHECKLIST
Undergraduate Applicants
Have you provided the following?
• Non-refundable application fee (KES. 3000 or US$ 50) - No cash payment q
• Complete and signed application form (please observe deadlines below) q
• Originals and a copy of all transcripts, diplomas, & certificates q
(N.B. originals will be returned)
• One (1) recent passport size photograph q
(write your name on reverse side)
• Copy of National Identity Card or Birth Certificate q
• School Leaving Certificate q
• Kenya National Qualifications Authority (KNQA) Equation Certficate q
(for all Foreign Qualifications)

Graduate Applicants
Have you provided the following?
• Non-refundable Application fee (KES. 3000 or US$ 50) - No cash payment q
• Complete and signed application form (please observe deadlines below) q
• Original and copy of the degree certificate and transcripts for each college or q
professional school previously attended. (Transcripts should indicate when the degree was
granted alongside syllabi of any college work taken to date)
• Originals and a copy of all supportive documents q
• A two page essay addressing these two topics: q
(1) What experiences led you to select your professional objectives
(2) What other two factors would you like to be
considered in evaluating your application
• A curriculum vitae/resume q
• Two letters of recommendation (forms enclosed) q
• One (1) recent passport size photograph q
(write your name on reverse side)
• Copy of National Identity Card or Birth Certificate q
• Kenya National Qualifications Authority (KNQA) Equation Certficate q
(for all Foreign Qualifications)

International Students
Have you provided the following additional items? q
• An official translation of academic records (where applicable) q
• An official test of English (TOEFL) or equivalent q
• A current financial guarantee letter q
• Completed Pupil’s Pass form q
• Two (2) recent passport size photographs (write your names on reverse side) q
• Pupil Pass processing fee of KES. 5000 - No cash payment (applicable to Non-East Africans) q
• Applicant’s copy of National passport q
• Sponsor’s copy of National passport q
• Certificate of Good Conduct q
ONLY COMPLETE APPLICATIONS WILL BE PROCESSED.
DEADLINES MUST BE OBSERVED. APPLICATION DEADLINES FOR USIU-AFRICA ARE AS FOLLOWS:

Semester Deadline Housing Deadline

Fall (September) June 30 July 31
Spring (January) September 30 October 30
Summer (May) March 15 April 1
COMPLETE APPLICATIONS RECEIVED AFTER THE DEADLINE WILL BE PROCESSED FOR THE FOLLOWING SEMESTER.

USIU-AFRICA RESERVES THE RIGHT OF ADMISSION