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Application Form - Revised 1-8-2023

This document is a course application form for the Technical University of Mombasa. It requests information such as the applicant's name, contact details, academic history, sponsorship, and a declaration agreeing to the university's terms. The form must be submitted along with supporting documents and payment of application fees in order to be considered for admission to a course at the university.

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Hydel Johnkamweru
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62 views

Application Form - Revised 1-8-2023

This document is a course application form for the Technical University of Mombasa. It requests information such as the applicant's name, contact details, academic history, sponsorship, and a declaration agreeing to the university's terms. The form must be submitted along with supporting documents and payment of application fees in order to be considered for admission to a course at the university.

Uploaded by

Hydel Johnkamweru
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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TECHNICAL UNIVERSITY OF MOMBASA

Document: Form Ref No.: TUM/Form/RAA/007

Title: Course Application Form

Department: Management Representative

Issue No. 2 Revision No. 1 Date: 1st August 2023

Course Applied: … … … … … … … … … … … … … … … … … … … … … … … … … … … ……………….

In the Department of … … … … … … … … … … … … … … … … … … … … … … .. … … … … ……………

CAMPUS (KWALE, LAMU, MAIN) ……… ……… ………… ………

First Name ……………………. M i d d l e N a m e …………………… Surname (Last Name) ……………………….

Titl e ( M r. , M s . M r s . , M i s s ) …………... Gender (M/ F)………… Date of Birth…………… ID/Passport No …………

County … … … … … … … … … … ..… … … . … … … … … … …...Sub - County …………………………………. …………………

Name o f Parent or G uardian: ……………………………..……………………………….…………..……..

Permanent Address: ………………………………………………… Phone-Number:………………….……………..……

Contact Addr ess: ……………………………………………. Town:.………………………………..………………………

Applicant’s Phone Number: … … … … … … … … … … … … Email: …………..….…………….…………….……….

Index No./Old Reg. N o: . … … … … … … … … … . … Nationality: … … … … ………. … …. Marital status: ……………

ACAD EM IC BACKGROUN DS

Institution Attended Dates Qualifications


(Start Year to Completion Year) Attained

DO YOU HAVE ANY PHYSICAL CHALLENGES: Yes No

TUM is ISO 9001:2015 Certified


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Working Experience
Nam e of Organization D ate
(Star t with current) Post Held From(year) To (year)

NB: Attachcopies of the relevant certificates, ONE recent passport size photograph, Copy of
National ID/Birth Certificate copy, Application fee receipt copy and any testimonial(s)
SPONSORSH:

Sponsor’s (Self, Parent, Organization) Name: ………………………………………………………………

Address of sponsor: … … … … … … … ……Town: …………………………... Phone Number………………

TERM S AND COND ITIONS OF ADMISSION.

1. At t ach a copy of the application payment receipt of a non-refundable fees of Kshs 3,000/= for
PhD, Kshs 2,000/= for Masters, Kshs 1,500/= for Bachelors, Kshs 1000/= for Diploma &
Certificate course, and Kshs 500 for short courses.
Fees must be paid in accordance with the fee schedule through the below Bank accounts.
Please attach the bank-slip: -
a) Cooperative Bank of Kenya (Nkrumah) Acc. No. 01129079001600
b) Standard Chartered Bank (Treasury Square) Acc. No. 0102092728000
c) Equity Bank (Digo Road Branch) Account No. 0460297818058
d) National Bank (T.U.M. Branch) Account No. 01038074211700
e) Barclays Bank (Nkrumah Road) Account No. 2034098894
f) KCB (Mvita Branch -Msa) Account No. 1169329578
g) KCB (Lamu Campus) Account No. 1118817192

2. Students should have paid 50% of the 1st Semester fees of the course to be allowed in class
3. A Copy of this form to be completed with the accurate details and returned to the Registrar of
Technical University of Mombasa, P. O. Box 90420-80100, Mombasa or email:
[email protected] or [email protected] or drop your applications at the Technical University
of Mombasa- Admissions Registry.
4. The dully completed forms should be returned on or before the last registration period
DECLARATION

I, ……… ……………………… ………………………declare that the information given in this application


form is correct. I further certify that I have read, understood and agreed to comply with the terms
stipulated herein.
Sign. ………………………… ………………………… Date………………………… ………….

FOR OF FIC IAL USE ONLY

DATE SELEC TED REJECTED PENDING


(Qualified) (Does not Qualify) (Missing Docs.)

Name of CoD… … … … … … … … … … … … … … … … … … … … .. Sign: …………………… Date: ……………………

Year of Study ……………………………………………….… Sem ester …………………….………… …

Name of Dean of School/Institute…………………………………. Sign……… … ……… … … …… Date……………………

TUM is ISO 9001:2015 Certified


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