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HEKIMA COLLEGE
Office of Admissions
P.O. Box 21215-00505 Nairobi, Kenya
Tel: 254-020-3876608 Fax 254-020-3870
972
APPLICATION FORM
Personal Information
Legal name_________________________________________________________________________
Surname
First
Middle
Date of birth
MM
D D
Y Y Y Y
Male Female
Current Address_____________________________________________________________________
Postal Address
_________________________________________________________________
City
Country
Telephone
Permanent Address___________________________________________________________________
Postal Address
________________________________________________________________
City
Country
Telephone
E-mail Address______________________________________________________________________
Nationality _________________________Country
of birth__________________________
Applicant Information
School/Institute applying to____________________________________________________________
Programme of study__________________________________________________________________
Degree sought
BA/BTh PGDip
MA Special student
Certificate
Education Information
Please list below all Colleges, Universities
or Professional School you have attended.
Institution
Location
Field
of Study
Date: from - to
Degree/Qualification
Indicate professional, research or
teaching experiences pertinent to your present study aspiration.
Institution
Location
Position
Date:
from - to
Name of persons who will submit letters
of recommendation (at least one academic).
Name
Title
Address
Academic awards________________________________________________________________________
Publications____________________________________________________________________________
(Attached additional list if necessary)
Language Proficiency
Language
Reading
Writing
Speaking
If English is not your first language
provide a proof of proficiency : TOEFL____________ or other LANGUAGE
TEST Score__________________________________________________________
Religious Information
This will not have any adverse treatment
of your application. Being a Jesuit Institution, Hekima College cares
for the integral education of a person including spiritual values.
Religion________________________________________________________________________
Religious affiliation or denomination_________________________________________________
Religious Institute or Diocese________________________Lay
Fraternity____________________
I hereby certify that the information
in this application is complete and accurate.
Signature________________________________
Date____________________________________