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Undergraduate Application Form Edited

This document is an undergraduate course application form for Taita Taveta University. It requests personal information from the applicant such as name, date of birth, contact details, education history, course applying for, sponsor details, and emergency contact. Terms and conditions for the application are also listed.

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Dickson Samson Alex
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46 views

Undergraduate Application Form Edited

This document is an undergraduate course application form for Taita Taveta University. It requests personal information from the applicant such as name, date of birth, contact details, education history, course applying for, sponsor details, and emergency contact. Terms and conditions for the application are also listed.

Uploaded by

Dickson Samson Alex
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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F-2-3-15-3

TAITA TAVETA UNIVERSITY


UNDERGRADUATE COURSE APPLICATION FORM
(To be filled in duplicate)

NAME (Surname first):_________________________________________________________________

Gender: Male [ ] Female [ ] Date of Birth (dd/mm/yy): _____________________________________

Nationality: ______________________________ ID / Passport No.______________________________

Name of Parent or Guardian: _____________________________________________________________

Permanent Address: ___________________________ Contact Address: ___________________________

Telephone: _______________________________ Fax: _______________________________________

Email: _______________________________________________________________________________

COURSE APPLIED FOR: ___________________________________________________________

Intake Date: _________________________________________________________________________

Mode of Study (Evening / Full-time / School Holidays / Weekend):______________________________

Education:

Schools /Institutions attended Date Qualification


From (year ) to (year)

Have you ever been expelled or discontinued from another institution of learning? Yes/No
(Circle as appropriate). If yes, attach details.
Attach copies of the following documents:
 Relevant certificates KCSE Result Slip/Certificate 
 School Leaving Certificate 
 National ID card/ ID. Application Waiting Card/Birth Certificate 
 Two Coloured Passport Size Photograph, and 
 A Copy of Application form receipt of Kshs. 1,500. It can be paid through; 

BANK: Kenya Commercial Bank (KCB) OR BANK: Equity Bank


ACCOUNT NAME: Taita Taveta University ACCOUNT NAME: Taita Taveta University
BRANCH: Voi Branch BRANCH: Voi Branch
ACCOUNT NUMBER: 1135369682 ACCOUNT NUMBER: 0790299712769
P.O. Box 635 - 80300 Voi, Kenya. Home of Ideas Tel: 020 2437267 / 0774222064
Note: The application form will not be accepted unless all the stated documents above are attached.

Sponsorship

Self
Others (parent, organization) ______________________________ Address: _____________________

Telephone No.:_______________________________________________________________________

Name and Address of the nearest relative/person or agency to be contacted in case of emergency

Name: _______________________________________________ Relationship: ___________________

Address: ______________________________________________ Telephone: ____________________

TERMS AND CONDITIONS

Fees must be paid in advance or on the opening date:

1. The courses will be conducted if the university senate approved quorum is realized.
2. Fees must be paid in advance or on the opening date
3. A service fee of Kshs. 2,000/= will be charged on all returned cheques.
4. A 20% will be charged on any booking cancelled before commencement of class
5. TTUC accept no liability of loss or damage to any property brought or left on the premises by
students.
6. TTUC does not accept any liability whatsoever for any injuries incurred during the training.
7. Students will be charged for any damage caused to equipment.
8. Students will not be allowed to change from one course to another (where applicable) once the
short listing is completed.

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.

Signature: _________________________________ Date: ___________________________

FOR OFFICIAL USE ONLY

Serial No. Receipt No Sponsor Date Qualified Documents Selected


Received Verified

Signature: _____________________________________ Date: ___________________________

REGISTRAR (ACADEMIC, RESEARCH AND OUTREACH)

P.O. Box 635 - 80300 Voi, Kenya. Home of Ideas Tel: 020 2437267 / 077422064

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