UoEJ1/2

UNIVERSITY OF ELDORET Affix your

Passport size
Photo here

STUDENT’S PERSONAL DETAILS

Information provided in this Form is intended to help the office of the

Registrar Academic understand the student better. It will be used for
purposes of improving the student’s welfare while at the University. (To be
completed in quadruple (4 copies) and in capital letters. Attach a
coloured passport size photograph taken on a yellow background on
each form.
(NOT FROM A ‘PHOTO ME’ MACHINE)

1. Full Name:___________________________________________
(Surname or last Name) (Other Names)

Current Mobile No._____________________________________

2. National Identity Registration No.ID __________District _________

3. University Admission Number _____________________________
4. Date of Birth ___________________________________________
5. Religion ______________________________________________
6. Nationality _____________________________________________
7. Home Contact Address __________________________________
_____________________________________________________
8. (a) Marital Status _____________________________________
(b) Name and Address of Spouse (if married) ______________
(c) Occupation of Spouse _____________________________
(d) Number of Children _______________________________
9. Full Name of father _________________________Deceased/Alive
10. Full Name of mother ________________________ Deceased/Alive
11 (a) Occupation of Father __________Date of Birth __________
(b) Occupation of mother __________Date of Birth __________
12. Names of brothers and sisters _____________________________
_____________________________________________________
13. Place of Birth: Village/Town _______________________________
Location ___________________ Name of Chief ___________
Division ______________District ___________County _________
14. Place of Permanent Residence: Village/Town _________________
Nearest Town ________Location _________Name of Chief______
Division____________ District____________ Province _________
Nearest Police Station __________________________________

28
15. Give names and address of two persons who can be contacted in
case of an emergency.

(a) Name ___________________Relationship______________

Address & Tel. No. ________________________________

b) Name __________________Relationship _____________

Address & Tel. No. ________________________________

16. Name and address of School attended for ‘O’ level _____________

17. K.C.S.E Results (Subjects and Grades)

_____________________________________________________

________________________Index Number __________________

18. Any other institutions/attended and qualifications attained

_____________________________________________________

19. Games/Sport: Which games are you interested in?

_____________________________________________________

20. Clubs, Societies and hobbies. Which clubs, societies and hobbies
are you interested in?

____________________________________________________

21. Do you suffer from any physical impairment? If so give details

_____________________________________________________

22. Please give any information you think is useful for you to
communicate to the University.

_____________________________________________________

I certify that the information I have provided is correct.

Signature_____________________ Date___________________

29
 UoEJ1/2
UNIVERSITY OF ELDORET Affix your
Passport size
Photo here

STUDENT’S PERSONAL DETAILS

Information provided in this Form is intended to help the office of the

Registrar Academic understand the student better. It will be used for
purposes of improving the student’s welfare while at the University. (To be
completed in quadruple (4 copies) and in capital letters. Attach a
coloured passport size photograph taken on a yellow background on
each form.
(NOT FROM A ‘PHOTO ME’ MACHINE)

1. Full Name:___________________________________________
(Surname or last Name) (Other Names)

Current Mobile No._____________________________________

2. National Identity Registration No.ID __________District _________

3. University Admission Number _____________________________
4. Date of Birth ___________________________________________
5. Religion ______________________________________________
6. Nationality _____________________________________________
7. Home Contact Address __________________________________
_____________________________________________________
8. (a) Marital Status _____________________________________
(b) Name and Address of Spouse (if married) ______________
(c) Occupation of Spouse _____________________________
(d) Number of Children _______________________________
9. Full Name of father _________________________Deceased/Alive
10. Full Name of mother ________________________ Deceased/Alive
11 (a) Occupation of Father __________Date of Birth __________
(b) Occupation of mother __________Date of Birth __________
12. Names of brothers and sisters _____________________________
_____________________________________________________
13. Place of Birth: Village/Town _______________________________
Location ___________________ Name of Chief ___________
Division ______________District ___________County _________
14. Place of Permanent Residence: Village/Town _________________
Nearest Town ________Location _________Name of Chief______
Division____________ District____________ Province _________
Nearest Police Station __________________________________

30
15. Give names and address of two persons who can be contacted in
case of an emergency.

(a) Name ___________________Relationship______________

Address & Tel. No. ________________________________

b) Name __________________Relationship _____________

Address & Tel. No. ________________________________

16. Name and address of School attended for ‘O’ level _____________

17. K.C.S.E Results (Subjects and Grades)

_____________________________________________________

________________________Index Number __________________

18. Any other institutions/attended and qualifications attained

_____________________________________________________

19. Games/Sport: Which games are you interested in?

_____________________________________________________

20. Clubs, Societies and hobbies. Which clubs, societies and hobbies
are you interested in?

____________________________________________________

21. Do you suffer from any physical impairment? If so give details

_____________________________________________________

22. Please give any information you think is useful for you to
communicate to the University.

_____________________________________________________

I certify that the information I have provided is correct.

Signature_____________________ Date___________________

31
 UoEJ1/2
UNIVERSITY OF ELDORET Affix your
Passport size
Photo here

STUDENT’S PERSONAL DETAILS

Information provided in this Form is intended to help the office of the

Registrar Academic understand the student better. It will be used for
purposes of improving the student’s welfare while at the University. (To be
completed in quadruple (4 copies) and in capital letters. Attach a
coloured passport size photograph taken on a yellow background on
each form.
(NOT FROM A ‘PHOTO ME’ MACHINE)

1. Full Name:___________________________________________
(Surname or last Name) (Other Names)

Current Mobile No._____________________________________

2. National Identity Registration No.ID __________District _________

3. University Admission Number _____________________________
4. Date of Birth ___________________________________________
5. Religion ______________________________________________
6. Nationality _____________________________________________
7. Home Contact Address __________________________________
_____________________________________________________
8. (a) Marital Status _____________________________________
(b) Name and Address of Spouse (if married) ______________
(c) Occupation of Spouse _____________________________
(d) Number of Children _______________________________
9. Full Name of father _________________________Deceased/Alive
10. Full Name of mother ________________________ Deceased/Alive
11 (a) Occupation of Father __________Date of Birth __________
(b) Occupation of mother __________Date of Birth __________
12. Names of brothers and sisters _____________________________
_____________________________________________________
13. Place of Birth: Village/Town _______________________________
Location ___________________ Name of Chief ___________
Division ______________District ___________County _________
14. Place of Permanent Residence: Village/Town _________________
Nearest Town ________Location _________Name of Chief______
Division____________ District____________ Province _________
Nearest Police Station __________________________________

32
15. Give names and address of two persons who can be contacted in
case of an emergency.

(a) Name ___________________Relationship______________

Address & Tel. No. ________________________________

b) Name __________________Relationship _____________

Address & Tel. No. ________________________________

16. Name and address of School attended for ‘O’ level _____________

17. K.C.S.E Results (Subjects and Grades)

_____________________________________________________

________________________Index Number __________________

18. Any other institutions/attended and qualifications attained

_____________________________________________________

19. Games/Sport: Which games are you interested in?

_____________________________________________________

20. Clubs, Societies and hobbies. Which clubs, societies and hobbies
are you interested in?

____________________________________________________

21. Do you suffer from any physical impairment? If so give details

_____________________________________________________

22. Please give any information you think is useful for you to
communicate to the University.

_____________________________________________________

I certify that the information I have provided is correct.

Signature_____________________ Date___________________

33
 UoEJ1/2
UNIVERSITY OF ELDORET Affix your
Passport size
Photo here

STUDENT’S PERSONAL DETAILS

Information provided in this Form is intended to help the office of the

Registrar Academic understand the student better. It will be used for
purposes of improving the student’s welfare while at the University. (To be
completed in quadruple (4 copies) and in capital letters. Attach a
coloured passport size photograph taken on a yellow background on
each form.
(NOT FROM A ‘PHOTO ME’ MACHINE)

1. Full Name:___________________________________________
(Surname or last Name) (Other Names)

Current Mobile No._____________________________________

2. National Identity Registration No.ID __________District _________

3. University Admission Number _____________________________
4. Date of Birth ___________________________________________
5. Religion ______________________________________________
6. Nationality _____________________________________________
7. Home Contact Address __________________________________
_____________________________________________________
8. (a) Marital Status _____________________________________
(b) Name and Address of Spouse (if married) ______________
(c) Occupation of Spouse _____________________________
(d) Number of Children _______________________________
9. Full Name of father _________________________Deceased/Alive
10. Full Name of mother ________________________ Deceased/Alive
11 (a) Occupation of Father __________Date of Birth __________
(b) Occupation of mother __________Date of Birth __________
12. Names of brothers and sisters _____________________________
_____________________________________________________
13. Place of Birth: Village/Town _______________________________
Location ___________________ Name of Chief ___________
Division ______________District ___________County _________
14. Place of Permanent Residence: Village/Town _________________
Nearest Town ________Location _________Name of Chief______
Division____________ District____________ Province _________
Nearest Police Station __________________________________

34
15. Give names and address of two persons who can be contacted in
case of an emergency.

(a) Name ___________________Relationship______________

Address & Tel. No. ________________________________

b) Name __________________Relationship _____________

Address & Tel. No. ________________________________

16. Name and address of School attended for ‘O’ level _____________

17. K.C.S.E Results (Subjects and Grades)

_____________________________________________________

________________________Index Number __________________

18. Any other institutions/attended and qualifications attained

_____________________________________________________

19. Games/Sport: Which games are you interested in?

_____________________________________________________

20. Clubs, Societies and hobbies. Which clubs, societies and hobbies
are you interested in?

____________________________________________________

21. Do you suffer from any physical impairment? If so give details

_____________________________________________________

22. Please give any information you think is useful for you to
communicate to the University.

_____________________________________________________

I certify that the information I have provided is correct.

Signature_____________________ Date___________________

35