Application Form Postgraduate Jan2012 by KzOLGr

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									                                                                                                                    F-2-3-15-1
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              JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND TECHNOLOGY
                                      ARUSHA CENTRE

                            APPLICATION FORM FOR POSTGRADUATE DIPLOMA STUDIES
                   Notes

         I.    Two copies of this form to be completed with the accurate details and returned to The Director,
               JKUAT Arusha Centre, P.O. Box 16857, Arusha or e-mail arusha.centre@jkuat.ac.ke or dropped
               at the centre offices.
         II.   The form should be returned before the close of the application period. Late applicants may be
               considered for registration but at an administrative penalty.
         III. This form should be typed or completed in BLOCK LETTERS
                                                               SECTION A
      1. Name (Mr., Mrs., Miss., Ms.) ……………………………………………………....................
                                                                             (Surname)
          ..………………….. ………….                                                                ………………………………………….
               (First Name)                                                                            (Other Names)
      2. Employer (if applicable) ………………………………………………………………………………...
      3. Field of study…………………………………………………………………………………………….
      4. Current Address………………………………………………………................
      5. Telephone No. ………………………………..….Mobile No.………………………………….............
          Email ……..………………………………………………………………………..........................
      6. Permanent (if different from the current address)
          Address………………………………………………………………………….........................
      7. Telephone number……………………………Mobile number…………………………........................
      8. E-mail…………………………………………………………………………………………................
      9. Nationality………………………………………………………………………………………………
      10. Identity Card No. /Passport No. ………………………………………………………………………...


      P.O.Box 16857 Arusha, Tanzania                                                   Tel +255 683 226639/ 767 326639
      Email: arusha.centre@jkuat.ac.ke                                                 Web: www.jkuat.ac.ke




                                                        JKUAT IS ISO 9001:2008 Certified

                              Setting Trends in Higher Education, Research and Innovation
                                                                                                              F-2-3-15-1

    SECTION B
11. Colleges/Institutions attended, years attended and qualifications obtained……………..…………..
    ……..……..…………………………………………………………………………………………………
    …….………………………………………………………………………………………………………...
    …….………………………………………………………………………………………………………...
    …….………………………………………………………………………………………………………...
    …….………………………………………………………………………………………………………...
    …….………………………………………………………………………………………………………...
12. University education and qualifications obtained (state the dates you attended the University
    Institution, the qualifications obtained, including classification e.g. First / Upper Second Class
    Honours). You should attach copies of the degree certificates and academic transcripts
    showing the grades obtained in each course.

   (a) First Degree
   (i) University attended ....………………………………………………………………………
   (ii) Dates attended..……………………………………………………………………………..
   (iii) Field of Study………………………..………………………………………………………
   (iv) Degree awarded .......………………………………………………………………………
   (v) Date awarded .………………………………………………………………………………

    (b) Second Degree (where applicable)
    (i) University attended ....………………………………………………………………………
    (ii) Dates attended..……………………………………………………………………………..
    (iii) Field of Study…………………………………………………………………………………
    (iv) Degree awarded .......………………………………………………………………………
    (v) Date awarded .………………………………………………………………………………
    (c) Additional qualifications (where applicable)
    ….…………………………………………………………………………………………………………..
    ….…………………………………………………………………………………………………………..
    …….………………………………………………………………………………………………………..
    ….…………………………………………………………………………………………………………..
13. Employment and Research experience (if any)
    (provide a list of publications and research grants received, on a separate sheet if necessary)
    …..………………………………………………………………………………………………………….
    …..………………………………………………………………………………………………………….
    …..………………………………………………………………………………………………………….
    …..………………………………………………………………………………………………………….
    SECTION C
14. The postgraduate course applied for
    (a) Name of degree ………………………………………………………………………………………
    (b) Department......………………………………………………………………………………………..
    (c) Faculty......…………………………………………………………………………………………......
    (d) Field of Study...………………………………………………………………………………………..
    (e) Pattern of study: Full-time ( )    Part-time ( ).




   P.O.Box 16857 Arusha, Tanzania                                                Tel +255 683 226639/ 767 326639
   Email: arusha.centre@jkuat.ac.ke                                              Web: www.jkuat.ac.ke




                                                  JKUAT IS ISO 9001:2008 Certified

                        Setting Trends in Higher Education, Research and Innovation
                                                                                                              F-2-3-15-1

15. Indicate how you intend to finance your studies
    …………………………………………………………………………………………………………….
    …………………………………………………………………………………………………………….
    …………………………………………………………………………………………………………….
16. Name two persons who are prepared to act as your referees. They should be well placed to report
    on your potential as a postgraduate student in your chosen field of study and preferably should
    have been your lecturer in degree courses. You should also fill in two request letters issued
    together with this form and forward them to your referees directly so that they can send their
    reference to the Director, Arusha Centre without delay. (Referees are not required
    for JKUAT academic Staff Members)

   Name……………………………………………………………………………………………………
   Address …………………………………………………………………………………….....................
   Telephone………………………………………Mobile No.……………………………………………
   Email…………………………………………………………………………………………………….

   Name …………………………………………………………………………………………….............
   Address ..…………………………………………………………………………………………............
   Telephone………………………………………Mobile No..……………………………………………
   Email……………………………………………………………………………………………………..

17. Signature of Applicant……………………………Date…………………………………………………

    SECTION D
    To be completed by the University
18. Recommendation by supervisors:
    (i) First supervisor …………………………………………………………………………………………
    ……………………………………………………………………………………………………………….
    ……………………………………………………………………………………………………………….
    ……………………………………………………………………………………………………………….
    Name………………………………………………………………………………………………………...
    Signature………………………………………Date……………….………………………………………

   ii) Second supervisor………………………………………………………………………………………
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   Name ....…………………………………………………………………………………………………….
   Signature ………………………………………Date………………………………………………………

   ii) Third supervisor (Where necessary).…………………………………………………………………
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   Name ....…………………………………………………………………………………………………….
   Signature
   …………………………………………………Date……………………………………………………
   P.O.Box 16857 Arusha, Tanzania                                                Tel +255 683 226639/ 767 326639
   Email: arusha.centre@jkuat.ac.ke                                              Web: www.jkuat.ac.ke




                                                  JKUAT IS ISO 9001:2008 Certified

                        Setting Trends in Higher Education, Research and Innovation
                                                                                                             F-2-3-15-1


19. Recommendation by the Department Postgraduate Committee. (Enter below ACCEPT or REJECT
   as may be applicable)
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   ……………………………………………………………………………………………………………….
   Name of Chairman: ……………………………………………………………………………………….
   Signature:……………………………………………………………………………………………..........
   Department of:.....………………………………………………………………………………………….
   Date .....................…………………………………………………………………………………………

20. Recommendation by the Faculty / School / Institute Postgraduate Studies Committee (Enter below
   ACCEPT or REJECT as may be applicable)
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   Name of Dean of Faculty / Director of School / Institute: ……………..……………………………..
   Signature: …………………………………………………………………………………………………
   Faculty / School / Institute.......…………………….…………………………………………………….
   Date ....................................……………………………………………………………………………..

21. Recommendation by the Board of Postgraduate Studies
   (Enter below ACCEPT or REJECT as may be applicable)
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   ………………………………………………………………………………………………………………
   Name of Director: …………………………………………………………………………………………
   Signature: .........…………………………………………………………………………………………..
   Date .................……………………………………………………………………………………………




  P.O.Box 16857 Arusha, Tanzania                                                Tel +255 683 226639/ 767 326639
  Email: arusha.centre@jkuat.ac.ke                                              Web: www.jkuat.ac.ke




                                                 JKUAT IS ISO 9001:2008 Certified

                       Setting Trends in Higher Education, Research and Innovation
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