Affix one of your
APPLICATION REF. NO ………………………………
current passport
size photo here
Telephone: +254 727 616 783
Website: www.actionafricainstitute.org
Email:
[email protected] ACTION INSTITUTE FOR PROFESSIONAL STUDIES
APPLICATION FORM FOR ADMISSION
(A Copy of this form should be completed, scanned and sent to the Academic Registrar (Admissions). The form should be typed or
completed in Block letters. Attach a passport size photograph, a copy of Result Slips / or Certificates and any other supporting
documents).
SECTION A – Course Application Details
i) Name of Certificate/Diploma/ Post Graduate Diploma course applied for ...………………………………………………………
SECTION B – Applicant’s Personal Details
ii) Name ……………………………………………………………………………………………….………………………………
(Surname) (Other Names in full)
iii) Postal Address …………………………………………………………....…… …………………………………………………..
iii) Postal Code…….…………….…… Town/City……………………. Country………………...………….……………
iv) Telephone……………………… Fax …...………………….…… E-Mail ………………….……………………...
Nationality ……………………...
National I.D.……………………… Passport No
SECTION C – Applicant’s Education Background
Please list all school/colleges you have attended:
Sec &Post –Sec Schools Address of School From To Qualifications Obtained Index No. /
Exam Reg.No.
1
PLEASE ATTACH COPIES OF CERTIFICATES, ACADEMIC TRANSCRIPTS AND RESULT SLIPS.
SECTION D – Applicant’s Working Experience
Record of Employment
YEAR EMPLOYER DESIGNATION NATURE OF ASSIGNMENT
FROM TO
SECTION E – Applicant’s Referees
Give names and addresses of two referees.
i) Name
…………………………………………………………………………………………………...……………………………….
Postal Address ……………………………………………………………………………………………………………………….
Postal Code…….…………….…… Town/City……………………. Country………………...………….……………
Telephone.……………………… Fax …...………………….…… E-Mail …………………...…………………….
ii) Name
…………………………………………………………………………………………………………………...…………….
Postal Address ………………………………………………………………………………………………………………………
Postal Code…….…………….…… Town/City……………………. Country………………...………….……………
Telephone.……………………… Fax …...………………….…… E-Mail ………………….…………………….
SECTION F – Applicant’s Declaration
I declare that the information given herein is true and accurate to the best of my knowledge and fully understand that any information
found to be false would lead to automatic disqualification.
Applicant’s Full Name……………………………………… ID/Passport No…………….…………
Date…………………………. Applicant’s Signature………………………………
