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Mature Entry Application Form - Moi University

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					                                                                FOR OFFICIAL USE ONLY

                                                                SERIAL NO…………………….…

                                                                RECEIPT NO………………………




                                 MOI UNIVERSITY
                           APPLICATION FOR MATURE ENTRY
                               2011/2012 ACADEMIC YEAR

     This form should be filled and returned to the Chief Academic Officer, Moi University,
                                 P.O. Box 3900, Eldoret, KENYA

                                         SECTION A
I.       PERSONAL DATA

         1.     Applicants Name …………………………………………………………………...……
                                         (Surname)   (Other Names)
         2.     Current Contact Address: ………………………………………………………………..
         3.     Permanent Address: ……………………………………………………………………..
         4.     Nationality: ………………………………………………………………………………
         5.     Date of Birth: …………………………………………………………….…………….…
         6.     Sex: …………………………………………………………………………….…………
         7.     ID/PP.No:…………………………………………………………………………………
         8.     Telephone No: …………………………………………………………………………...

II   RECORD OF SECONDARY SCHOOL EDUCATION (Attach copies of Result Slips and
     Certificates).
SCHOOL              FROM (YEAR)   TO (YEAR)      CERTIFICATE AND
                                                 GRADE OBTAINED




III  POST SECONDARY EDUCATION (Attach Copies of Result Slips and Certificates).
COLLEGE        FROM     TO          AREA OF STUDY          QUALIFICATIONS
               (YEAR)   (YEAR)                             ATTAINED




IV.   WORK/PROFESSIONAL EXPERIENCE
POSITION              EMPLOYER                            FROM (YEAR)      TO (YEAR)
                                     SECTION B
                                 DEGREE PROGRAMME

1.   Degree Applied for

     ……………………………………………………………………………………………………….

2.   Current Area of Specialization ……………………………………………………………………...
     (In case of Education/Technology state teaching/specialized subjects)

3.   How would you rate your English Communication Skills.

            Poor                    Good           Very Good               Excellent


4.   The spaces below should be signed by two persons of which one must be the head of your former
     / current institution who can act as your referees.

     (i)
     Name: ……………………………………………………………………………………………….

     Address: …………………………………………………………………………………………….

     Signature: ………………………………………….. Date ………………………………………...


     (ii)
     Name: ……………………………………………………………………………………………….

     Address: …………………………………………………………………………………………….

     Signature: ………………………………………….. Date ………………………………………...



     Signature of Applicant: ……………………………….. Date ………………………………….…



                             SECTION C (FOR OFFICIAL USE ONLY)


1.   Application Approved                          Not Approved

2.   Degree Programme: …………………………………………………………………………..……

3.   Comment:

     ……………………………………………………………………………………………….………

     ……………………………………………………………………………………………….………

     ……………………………………………………………………………………………………….

                                               2

				
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posted:10/29/2011
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