Scribd
Upload
5 views2 pages

membership application

The document is an individual membership application form for the Kenya Institute of Social Work, filled out by William Omondi Ochieng. He is applying for Silver membership, has a Bachelor's degree in Sociology, and has one year of government work experience. The application includes personal details, educational background, and a declaration of the truthfulness of the information provided.

Uploaded by

William Ochieng
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
5 views2 pages

membership application

The document is an individual membership application form for the Kenya Institute of Social Work, filled out by William Omondi Ochieng. He is applying for Silver membership, has a Bachelor's degree in Sociology, and has one year of government work experience. The application includes personal details, educational background, and a declaration of the truthfulness of the information provided.

Uploaded by

William Ochieng
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
You are on page 1/ 2

KENYA INSTITUTE OF SOCIAL WORK

(Membership Division)

INDIVIDUAL MEMBERSHIP APPLICATION FORM


APPLICANT’S PERSONAL DETAILS
TITLE__ MR.___________________________________________ ____________________

FULLNAME_________WILLIAM OMONDI OCHIENG _________________ ___________________________________

GENDER____________MALE______________________NATIONALITY___________KENYAN____________________

PHONE

NO__N/A___MOBILENO.___0792421615___EMAILADDRESS__WILLIAMOCHIENG01@GMAIL.COM_____POSTAL

ADDRESS__________42155-00100 GPO NBI__________________________ HIGHEST LEVEL OF

EDUCATION/TRAINING________BACHELOR OF ARTS (SOCIOLOGY)__________________________GRADE

OBTAINED____________PASS______________________

YEAR COMPLETED____________2021______________________ (Attach copy of Certificate) INSTITUTION

ATTENDED_______________UNIVERSITY OF NAIROBI _______________________________________________

P.O.BOX__________42155-00100 GPO NBI________TELEPHONE____0792421615_____ _________ WORK

EXPERIENCE:_1 YEAR IN GOVERNMENT____PROFESSIONAL REFEREE_______NEVILLE MUSIMA_ _

P.O.BOX________N/A__________________________TELEPHONE___0711731537 _____________________

LEVEL OF MEMBERSHIP BEING APPLIED FOR_____SILVER ________________________ ___

WHO INTRODUCED YOU TO KISWCD MEMBERSHIP_____N/A ______________ ______


APPLICANT'S DECLARATION

I confirm that the above information is true to the best of my knowledge and I am aware that giving false
information will lead to automatic disqualification.

NAME_WILLIAM OMONDI OCHIENG_SIGNATURE_____________DATE_26TH FEBRUARY 2025__

FOR OFFICIALUSEONLY

NAME OF THE OFFICER WHO RECEIVED THE FORM ______ _____________

SIGNATURE _____________ DATE _________________

HEAD OF DEPARTMENT

MEMBERSHIP APPROVED OR NOT__________ ______________________SIGNATURE________________

DATE_________________

OFFICIALRUBBER STAMP

You might also like