Scribd
Upload
257 views

CBET Application Form

Uploaded by

enock.murbii
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
257 views

CBET Application Form

Uploaded by

enock.murbii
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

RVIST/QMS/REG/F15

RIFT VALLEY INSTITUTE OF SCIENCE AND TECHNOLOGY


ISO 9001:2015 Quality Management System
MANUAL APPLICATION FORM
(DO NOT SUBMIT THROUGH EMAIL)
A. PERSONAL DETAILS
APPLICANT’S NAME (as it appears in the result slip) ID NEMIS (UPI) NUMBER

MOBILE PHONE DATE OF BIRTH (dd/mm/yyyy) MARITAL STATUS

POSTAL ADDRESS COUNTY SUB-LOCATION GENDER ( ck one)


FEMALE MALE
POSTAL CODE SUB-COUNTY VILLAGE EMAIL ADDRESS

TOWN LOCATION CITIZEN DISABLED? YES NO


IF DISABLED, STATE NATURE OF DISABILITY
NON-CITIZEN
B. ACADEMIC QUALIFICATIONS
CERTIFICATE SCHOOL/COLLEGE ATTENDED INDEX NO YEAR MEAN GRADE/
QUALIFICATION
KCPE
KCSE
CRAFT
DIPLOMA

C. SPONSOR/GUARDIAN DETAILS
FULL NAME POSTAL ADDRESS POSTAL CODE TOWN

RELATIONSHIP TO APPLICANT EMAIL ADDRESS MOBILE NUMBER OCCUPATION

E. COURSE DETAILS
COURSE NAME LEVEL ( ck one)
Level 4 Level 5 Level 6

MODE OF STUDY ( ck one) CAMPUS ( ck one)


Regular Evening Weekend MAIN NAKURU TOWN KERICHO TOWN
Holiday

I confirm the information given above is correct to the best of my knowledge and do take full responsibility for any incorrect information
Sign__________________________________ Date____________________________________

DEPOSIT Applica on Fee 500/= OFFICIAL USE ONLY


Main Campus COOP BANK A/C NO 01129087643400 VERIFIED BY ________________________________
Nakuru Town Campus KCB A/C No 1101786221
Kericho Town Campus TLB A/C No 43916001
Sign________________________ Date__________________________

A ach the following copies of tes monials


· Result Slip/Cer ficate (KCPE AND KCSE) Send your fully filled applica on form to:
The Principal, RIFT VALLEY INSTITUTE OF SCIENCE & TECHNOLOGY
· Birth Cer ficate
P. O. Box 7182-20100 NAKURU
· Na onal ID
OR DROP IT IN PERSON IN ANY OF OUR CAMPUSES

NOTE: Evening and Weekend available in Nakuru and Kericho Campus

You might also like