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UOE/STUU/01/014

APPLICATION FOR UNDERGRADUATE ADMISSION


This form should be completed by all prospective students willing to join University of Eldoret under the Privately
Sponsored Students Programme (PSSP). Fill form in block letters, attach testimonials and return to:-
Registrar (Academic), University of Eldoret,
P. O. Box 1125 -30100,
ELDORET, KENYA

SECTION A
Applicant’s Personal Information
Please fill in your official name and details

OFFICE OF THE DEPUTY VICE CHANCELLOR (Academic & Students’ Affairs) [QA-014©2013]
NAME: ___________________________________________________________________________________
(Surname) (Other names)

ID / PP. No.:________________________________________ GENDER: ☐Male ☐Female


(National ID /Passport No.) (Tick (√) as appropriate)

DATE OF BIRTH _____________________________ NATIONALITY:______________________________


(e.g. 22nd April 1980) (e.g. Kenyan)

EMAIL: _________________________________________________ PHONE: ___________________________


(Personal email address for contact) (Include country code)

POSTAL ADDRESS: _____________________________________________________________________________

SECTION B
Proposed Course Details
Please provide details of course and tick (√) boxes as appropriate.

Programme Applied for:-


☐ Degree ☐ Diploma ☐ Certificate ☐ Bridging

Programme:______________________________________________________________________________
(e.g. Mathematics/ Sustainable Development/ Business Management)
School __________________________________________________________________________________
(e.g. Agriculture & Biotechnology)
Proposed Academic Year of Study ____________________________________________________________
(e.g. 2013/2014)
Mode of Study
☐ Full-time ☐ Part-time ☐ School-Based

SECTION C
Finances

Indicate how you intend to finance your studies


☐ Scholarship ☐ Personal funding ☐ Others

Give Details of financing above______________________________________________________________

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SECTION D
Academic, Professional & Employment History
Please attach copies of transcripts and certificates as appropriate

No. Academic Institution Years Academic


(e.g. Secondary School, College, University attended) (e.g 1990-1994) Qualification
(e.g. KCSE, Dip., HND)

No. Professional Examining Body Years Professional


(e.g. KASNEB/ KNEC/University) (e.g 1995-1997) Qualification
(e.g. CPA(K))

No. Employer Years Position


(e.g. TSC/ Ministry of Lands) (e.g 1998-2005) (e.g. Teacher/ Clerk/
Researcher)

SECTION E
Applicant’s Declaration
Please read through the information filled in before signing.

I hereby declare that the information I have given in this form is correct

Signature: ____________________________________________ Date: _______________________________


(Applicant)

SECTION F
Official Use Only
To be filled by officer of University of Eldoret.
Candidate’s application;
☐ Accepted ☐ Rejected

Comments: ______________________________________________________________________________
If applicant ACCEPTED,

ADMISSION
NUMBER

Signature: _________________________________ ___________ Date: ________________________________


(Registrar -Academic)
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