FOR OFFICIAL USE ONLY

SERIAL NO…………
RECEIPT NO.

MOI UNIVERSITY
APPLICATION FOR MATURE ENTRY
2006/2007 ACADEMIC YEAR

A copy of this form should be completed and returned to the Chief Academic Officer,
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. …………………………………………………………………

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
 2
IV. WORK/PROFESSIONAL EXPERIENCE

POSITION EMPLOYER FROM TO

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.

Name: ………………………………………………………………………………………
Address: ……………………………………………………………………………………
Signature: ………………………………………….. Date ……………………………….
Name: ………………………………………………………………………………………
Signature: …………………………………………. Date ……………………………….
Address:
…………………………………………………………………………………….
Signature of Applicant ……………………………… Date ……………………………….

SECTION C (FOR OFFICIAL USE ONLY)

1. Application Approved Not Approved

2. Degree Programme:
…………………………………………………………………………
3. Comment:
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………