THE NYERI NATIONAL POLYTECHNIC
P.O. Box 465-10100 Tel: 061-2032330 Fax: 061-2032852 Mobile: 0724-477942
Website: www.thenyeripoly.ac.ke E-mail: info@thenyeripoly.ac.ke
NNP/ REG /ADM/APPLICATION FORM
APPLICANT’S DETAILS
SURNAME_________________ FIRST NAME____________________ MIDDLE NAME____________________
DATE OF BIRTH (DD/MM/YY) ____________ GENDER _________ TEL: ______________________________
ID /PASSPORT NUMBER HOME ADDRESS: ____________________
NATIONALITY ______________ E-MAIL ______________________________ DATE _________________
KCPE INDEX NO YEAR KCSE INDEX NO YEAR
EDUCATION DETAILS
COURSE APPLIED FOR ____________________________________________________________________
LAST SCHOOL ATTENDED _______________________________________YEAR______________________
MEAN GRADE ATTAINED ____________________________________________________
ENGLISH/KISW ___________________________________________________
MATHS _________________________________________________________
PHYSICS _________________________________________________________
CHEMISTRY/PHYSICAL SCIENCE ___________________________________
BIOLOGY/BIOLOGICAL SCIENCE ___________________________________
OTHER QUALIFICATIONS_____________________________________________________
PARENT’S/GUARDIAN’S DETAILS
SURNAME_________________ FIRST NAME______________________ MIDDLE NAME_____________________
P.O. Box _________________ POSTAL CODE TOWN _________________
TELEPHONE: FAX:
MOBILE:
E-MAIL _____________________________________________________
NOTE: ATTACH PHOTOCOPIES OF: KCPE CERTIFICATE, KCSE CERTIFICATE/RESULT SLIP, ID CARD, LEAVING CERTIFICATE
AND BIRTH CERTIFICATE.
OFFICIAL USE
Candidate qualified for the Course Yes No
HOD’s Comments __________________________________________________________________________