KCAU/LA/01

Thika Road, Ruaraka. P.O. Box 56808 - 00200 Nairobi, Tel: 0722 869 917/0792 793 056/0715 532 187/0734 888022
Website: www.kcau.ac.ke Email: registrar@kcau.ac.ke

LETTER OF ACCEPTANCE
(To be completed and submitted by the student accepting the offer)

Candidate’s Name: ..........................................................................................................................................................

(Surname) (Other Names)

Registration Number: .................................................... ID Number: .............................................................................

Degree Programme Admitted to: .....................................................................................................................................

SECTION A: ACCEPTANCE OF OFFER

I declare that I DO ACCEPT the offer and promise to abide by the Rules and Regulations governing the Conduct
and Discipline of Students of KCA University. I hereby undertake to complete the programme for which I have been
admitted unless I am discontinued by the University Senate.

I understand that changing the Programme will be permitted only by the approval of the University.

Student’s Signature: .................................................................... Date of Signature: ..............................................

Note: If you are not accepting this offer please complete and return section B of the form.

SECTION B: DECLINE OF OFFER

(To be completed by those NOT ACCEPTING the offer)

Candidate’s Name: ..........................................................................................................................................................

(Surname) (Other Names)

Registration Number: .................................................... ID Number: .............................................................................

Degree Programme Admitted to: .....................................................................................................................................

I DO NOT ACCEPT the offer to join KCA University because of the following reasons:
..........................................................................................................................................................................................
..............................................................................................................................................................…………………
Student’s Signature: .................................................................... Date of Signature: .................................................

KCAU/LA/01
KCA/AF/02 AFFIX 2
RECENT

PASSPORT

PHOTOS

GOVERNMENT SPONSORED STUDENT ADMISSION FORM

Complete all sections in block letters

Name of Course:
Index Number:

Transferees (Only fill this part if transferring from another University)

Name of the University Initially Placed
Course Admitted to at KCA University
Year of High School Completion

Applicant’s Name(s)
Surname First Middle

Date / Month / Year

Date of Birth: / / Female Male Religion:
Marital Status:
Place of Birth: Citizenship: Single Married
National ID No / Passport No: Residential District: Home Location:

County of Origin (Home County): County of Residence at the time of Any Form of Disability
admission: Yes No
Mailing Address/ Contacts
P.O. Box / Postal Code / Town Mobile No(s). Email Address
a)
/ /
b)

Next of Kin or Guardian’s Details (Contacts in case of emergency)

1. Name ……………………………………………………….. 2. Name ………………………………………………………..

Relationship to applicant……………………………………… Relationship to applicant………………………………………

Employer …………………………Designation ……………... Employer …………………………Designation ……………...

P.O. Box ………………..Postal Code ……………………….. P.O. Box ………………..Postal Code ………………………..

Town…………………….Telephone ………………………… Town…………………….Telephone …………………………

Email address ………....………................................................. Email address ………....……….................................................

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Contacts of other Family Member(s) (Contacts in case of emergency)

Name …………………………………Relationship to applicant………………………… Telephone………………............………

P.O. Box ………...............................Postal Code ……………………………..Town ……………………………………………….

Place of Residence…………………………………………… Email address……........……………………………………………

Guarantee of Fee Payment (tick where appropriate)

Parent Guardian Self Sponsor Employer

Name.......................................................... Contacts (Tel/Mobile) ................................................

Preferred Intake Year: January May September

Have you previously registered with KCA?

Yes No If yes, gives your KCA Reg. Number

Education (please list last secondary school and colleges attended)

Name Period attended

Course / Education ( Level attained
(School/College) From To e.g. certificate, diploma, degree) Grade/Award
a) Secondary / High School

b) College / University

Relatives who have attended KCAU (if any)

Name ……………………………………………….. Relationship ……………………………. Mobile No. ……………………………

Name ……………………………………………….. Relationship ……………………………. Mobile No. ……………………………

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How did you learn about KCA – Tick one

College Guide ☐ Newspaper ☐ TV ☐ Radio ☐ KCAU Website ☐ Exhibition ☐ Parent ☐ Relative ☐

Friend ☐ School Teacher ☐ KCAU Student ☐ KCAU faculty ☐ Mailing ☐ College / High School Fair ☐

Facebook ☐ LinkedIn ☐ Google ☐ Other (specify) …............……………………………………………………………….

Please indicate the sports and clubs you belonged to in high school in order of priority

Sports Leadership (Tick where applicable)

1. ……....................................................... ☐ President, Student Council

☐ School Captain

☐ Club / Society Officer

2. …….......................................................
☐ Class Monitor

☐ Academic Captains
3. ……....................................................... ☐ Game leader

☐ Time Manager

Others? (list here)

Clubs & Societies
1. …….......................................................
1. …….......................................................

2. …….......................................................
2. …….......................................................

3. …….......................................................
3. …….......................................................

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• All forms MUST be SIGNED before returning them to the Admissions Office. ORIGINALS and FOR OFFICIAL USE
COPIES of the following documents must be attached;

Certified &
1. National ID or Birth Certificate
Processed
2. O’ level Certificate or Result Slip
3. Academic Certificate and Transcripts
4. Two Colour Passport-Size Photographs Officer: ……………

• Admission fee (Kshs 1000) can be deposited in one of the following KCAU bank accounts:
Sign: ………………

Standard Chartered Bank, Ruaraka Branch Absa Bank, Westland’s Branch

Date: ………………
Account number: 0102001171100 Account number: 1352178
Bank code: 002 Bank code: 073
Swift code: SCBLKENX Swift code: BARCKENX
Payments can also be made using major credit and debit cards.
NO CASH PAYMENTS WILL BE MADE AND ACCEPTED IN THE UNIVERSITY

ORIGINAL DEPOSIT SLIP must be attached to the admission form when submitting to the admission office

ATTESTATION

I declare that I DO ACCEPT the offer and promise to abide by the Rules and Regulations governing the Conduct
and Discipline of Students of KCA University. I hereby undertake to complete the programme for which I have been
admitted unless the University Senate discontinue me.
I understand that changing the Programme will be permitted only by the approval of the University.
I hereby certify that the information given in this admission form is correct and complete to the best of my
knowledge, and by give my permission to the Admissions Office to obtain any verification deemed necessary. I
include with this form the official payment receipt /Bank deposit slip for the University fees and copies of other
documents as stated in the admission letter.

Signature:……………………………………….. Date:………………………………………

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Student Disclosure of Disability

The University has a responsibility to provide all students with equal rights to participate in education and to be treated with
dignity in a supportive learning environment. The University assists students with disabilities and/or significant health conditions to
complete all University learning activities within the context that the interests of all parties affected are balanced and risks
minimised. All of the University's programs and courses are available to people living with disability and/or significant health
conditions, unless a reasonable accommodation cannot be made that maintains the academic, clinical and professional
requirements of the Program/Course detailed in the Program Learning Outcomes (PLOs) or will cause unjustifiable hardship to
the University.

KCA University asks students to disclose relevant information about circumstances that may impact on their capacity to undertake
their studies and for the purpose of making reasonable adjustments. Students have the option to complete this non- compulsory
Disclosure Statement.

Section A
Do you have a disability, health condition, or illness; or are you the primary care giver of a person with a disability, health
condition, or illness, that is likely to impact upon your (his/her) capacity to fulfil the requirements of a learning activity in a
University program?
Please tick the box which you feel relates to you

You have a social/communication impairment such as Asperger's syndrome You are

blind or have a serious visual impairment
You are deaf or have a serious hearing impairment
You have a long standing illness or health condition such as cancer, HIV or epilepsy
You have a mental health condition, such as depression or anxiety disorder
You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
You have physical impairment or mobility issues
You have two or more impairments and/or disabling medical conditions
Autistic Spectrum Condition
Other (disability, impairment or medical condition that is not listed above)
You do not have a disability
If you have declared a disability:
Have you enclosed a letter from your General Practitioner (GP) or Specialist? Yes ☐ No ☐ If No,
when will you be able to send this to us?
Have you enclosed the report from the Educational Psychologist? Yes ☐ No ☐
If No, when will you be able to send this to us?

Please enclose a copy of a current medical letter or a report from an educational psychologist and return this form
to: Admissions Office, Block C Welcome Centre. If you wish to withdraw your consent at any point please contact
us at registrar@kca.ac.ke or visit the Admissions Office for assistance.

Section B

I have read and understood the information on this form relating to disclosure of information about my disability and consent to
my information, as described above, to be used and shared for the purpose of making reasonable adjustments to offer
supportive learning environment. (If you do not consent to this, please speak to an Advisor and do not sign below).

Student Signature: ………………………..……. Date: …………………............................

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 KCAU/PG/03

Thika Road, Ruaraka. P.O. Box 56808 - 00200 Nairobi, Tel: 0722 869 917/0792 793 056/0715 532 187/0734 888022
Website: www.kcau.ac.ke Email: registrar@kcau.ac.ke

PARENT / GUARDIAN CONSENT FORM

(To be completed by parents or guardian)

Name of Student: ................................................................................................................................................................

University Registration Number: ........................................................................................................................................

Degree programme admitted to: .........................................................................................................................................

I give consent as a parent/guardian to allow…………………………………...................................................................

pursue his /her course at KCA University, abiding by the Rules and Regulations of the University.

1. Name of Parent(s): .............................................................................................................................................................

Signature: .............................................................. Telephone / Mobile: ..........................................................................

Date: ......................................................................

2. Name of Guardian: .............................................................................................................................................................

Signature: .............................................................. Telephone / Mobile: ..........................................................................

Date: ......................................................................

3. Contacts in case of Emergency

Name: ……………………………………………………….. Relationship to applicant: …….………………………..

Telephone / Mobile: ...………………………….….. Email address: ……………………………….………………….

P.O. Box: …………….............................. Postal Code: ……………………….. Town: ……………….……...............

NB: Form to be returned to the university upon completion.

KCAU/PG/03
 KCAU/MED/04

Thika Road, Ruaraka. P.O. Box 56808 - 00200 Nairobi, Tel: 0722 869 917/0792 793 056/0715 532 187/0734 888022
Website: www.kcau.ac.ke Email: registrar@kcau.ac.ke

STUDENTS MEDICAL EXAMINATION

Students are requested to complete Part I of this Form. Part II should be completed by the Medical Officer examining
the Student. The completed Form should be brought personally and presented to the Medical Officers on the day of
Registration by the Student. No medical reports should be brought earlier or sent by post.
NB: Information provided will be treated with confidentiality and will not be used against the student

PART I

First Name Middle Name Surname /Last Name

Faculty/ School:

Telephone/Mobile: Nationality: Date of Birth:

Gender: Marital Status: Date Month Year

Physically challenged: Yes No

If yes, specify:

Next of Kin Details (Contacts in case of Emergency)

Name ………………………………………………….......... Relationship to applicant………………………………..

Occupation……………………. P.O. Box ……………......... Postal Code ……………… Town……………………..
Telephone/Mobile...………………………………….. Email address…….……………………....................................

Do you have any medical condition that would require special attention or support?......................................................

If yes, provide details including the doctor’s contact and address (to be used in case of emergency)
...........................................................................…………………………………………………………………………

KCAU/MED/04
 PART II
(To be completed by the Examining Medical Officer)
a) Visual Acuity Without Glasses R.6/................................ L./6.......................................

With Glasses R.6/ .............................. L./6.......................................

Any other critical observation………………………………………………

b) Hearing Right Ear............................... Left Ear...............................

Any other critical observation………………………………………………

c) Circulatory Pulse: Blood Pressure Systolic Diastolic

System

d) Respiratory Any other critical observation

System

e) Abdomen
(Organomegally)

f) Urine………….. Albumin………….. Sugar………….. PDT…………..

g) Any observable physical disabilities in addition to general record of observation

…………………………………………………………………………………………………….

h) Is the student on any treatment? ......................................................................................................

If any, please specify........................................................................................................................

Date: Medical Officer: Address: Stamp:

NB: Attach any supportive document of the above examination findings

PART III
(To be completed by the University Medical Officer)

Special Remarks:…………………..…………………………………………………………………………..

………………....................................................................................................................................................

Will the student need any special support during his or her studies?................................................................

Date: .................................................... ...........................................................................

University Medical Officer
FOR KCA UNIVERSITY

KCAU/MED/04
KCA/RR/05

RULES AND REGULATIONS

1.1 CLASS ATTENDANCE. Students may not be more than 5 minutes late for class. Class attendance
sheets must be signed for each lesson. Ensure your full correct name is in the attendance sheet.

1.2 TESTS & ASSIGNMENTS should be done as time tabled. Any exemptions from sitting tests and
examinations must be sought from the office of the Registrar well in advance.

1.3 FEE PAYMENT rules must be strictly observed. Any student found in class not having paid fees
will be EXPELLED unless he can show proof that he/she has such authority from the Finance
Director. Students MUST register as current students every new semester/trimester, to access
facilities and services in the university. Students found attending classes not paid for will be
SUSPENDED from the university and will be required to pay fees in full for that whole section.

1.4 UNIVERSITY IDENTIFICATION CARD should be carried at all times including copies of fees
receipts. No student will be allowed into the University without student ID. Any student found IN
THE ACT OF EXCHANGING STUDENT ID CARDS will be PENALIZED and SUSPENDED
from the university. Lost student cards must be reported immediately and will only be replaced at a
cost of Kshs.1000.

1.5 SMOKING & DRINKING is banned at KCAU. Students found smoking in the compound will
face the disciplinary committee and will be SUSPENDED from the University. Smoking of any
form of drugs e.g. bhang will result in EXPULSION. Drunkenness is completely unacceptable. Any
student reported to be drunk in the University will be suspended immediately.

1.6 FIGHTS, BRAWLS, FORGERY & THEFT will not be tolerated. Such cases will be treated as
criminal offences and will be referred to the police. Students involved in such offences will face the
disciplinary committee, where they will be EXPELLED or SUSPENDED depending on offence
committed.

1.7 MOBILE PHONES AND WALKMANS must not be put on while in class at all. Walkmans may
only be used in the fields out of class hours.

1.8 ARRESTS BY POLICE. Students are governed by the overall laws of the land that govern other
Kenyans and can be arrested by the police if they infringe these laws, whether on campus or outside.
In the event of such arrest, the student should immediately inform the University. Students should
note that the University will not interfere with the Police when they are carrying out their duties in
accordance with the laws of the land.

1.9 MEETINGS, PROCESSIONS AND DEMONSTRATIONS It is a serious offence for any student
to organize or participate in any meetings, demonstrations or processions for which permission has
not been granted by the University. Students should not undertake unauthorized ceremonies.
 1.9.1 UNIVERSITY PROPERTY A student or a group of students will be held-responsible for any
damage to University property as a result of misuse or willful destruction of such property by the
student or that group of students.

1.9.2 LOSS OR DAMAGE OF STUDENTS' PROPERTY. The University will not be held responsible
for losses or damage to students' property while at the University premises hence every student is
expected to take care of his/her valuables.

1.9.3 FIRE FIGHTING APPLIANCES. It shall be a serious offence against University regulations to
interfere with, damage or remove (other than for fire-fighting purposes) any firefighting appliances.

1.9.4 EMERGENCY In case of an illness, urgent crisis e.t.c students should report to the Nurse, Security
officer or the Dean of Students. In the absence of these officers, such reports should be made to the
Registrar and respective Deans of the faculties.

1.9.5 CORRESPONDENCE No students shall make any public statements on behalf of the students
association or students' societies on matters affecting the University without specific authority from
the relevant authority.

Invitations of Government ministers, politicians, and representatives of foreign countries to visit the
University in their official capacity shall be channeled through the University authorities.

2.1 UNIVERSITY FUNCTIONS AND EVENTS. All students are expected to adhere and respect
University functions and events. The university has authority to define the structure and dates for
such functions/events in line with the University’s activity plan. Students should also note that the
University will not re-schedule such events/ functions to suit particular needs of any individual
student.

2.2 DRESS CODE This dress code applies to all the days of the week and also to all KCA functions at
the CPA Centre and elsewhere. To ensure that high Professional and academic standards are
maintained; all students must dress decently and observe the following dress code;

Ladies will NOT be allowed into the University when wearing:

Tight trousers Long and multiple slit skirts
Tunk tops Tight clingy skirts
See-through tops Dress tops
Sleeveless tops Shorts or pedal pushers/Three quarter trousers
Mini Skirts Head gear including caps and scarves
Dread Locks
Colored braids except Black/brown

Gentlemen will NOT be allowed into the University when wearing:

Shorts Plaited or chemically treated hair Caps or any other
Earrings headgear Sandals
Dreadlocks Long Unkempt hair
Sleeveless tops
Sagging trousers

If students come in any of these items, the Security officers at the gate will request them to go back
home and change.
 REGULATION FOR UNIVERSITY EXAMINATIONS

ACADEMIC MISCONDUCT PENALTY

1 Plagiarism is the act of taking another's ideas a) Cancellation of the candidate's examination
and representing them as one's own including (course work, project/thesis)
coursework. This may involve the use, without b) Repeat the unit in which the offence was
proper acknowledgement, of published or committed during the following
Unpublished work, of work done partly or wholly semester/trimester with full payment
by another person, or of work obtained from an c) A written warning.
essay bank or a website. Plagiarism includes not
just the actual copying of text verbatim (which
may also be a breach of copyright) or close
paraphrasing of text, but also the
unacknowledged presentation of ideas garnered
from other sources as if they were original o the
author
2 Falsification is the fabrication or alteration of a) Cancellation of the candidate'sexamination
data for example, by changing data in order to results in the unit concerned.
confirm a hypothesis not supported by the actual b) Suspension from the University for one
data, o he invention or fabrication of the results trimester/semester
of an experiment, which are then reported as c) Repeat the unit in which the offence was
genuine measurements. committed during the following semester /
trimester with full payment

3 False citation is the citing of a source of a) Cancellation of the candidate's examination

information, when the source does not contain results in the unit concerned.
that information b) Suspension from the University for one
trimester/semester
c) Repeat the unit in which the offence was
committed during the following
semester/trimester with full payment
4 Multiple submission is the act of submitting for a) Cancellation of the candidate's examination
assessment a piece of coursework already (or results in the unit concerned.
simultaneously) submitted in another course, b) A written warning.
whether for academic credit or formative
assessment; this includes what is sometimes
known as auto plagiarism.
5 Aiding and Abetting any form of involvement a) Cancellation of the candidate's
in another person's academic misconduct is in examination results in the unit concerned.
itself considered to be academic misconduct. b) Suspension from the University for one
This may involve, for example, collusion with academic year (three trimesters / two
another person during an examination; assisting semesters)
any student in academic misconduct relating to c) Repeat the unit upon resumption with full
an examination of class test; writing an essay for payment.
a student; providing one's own work that could d) (Students proven to have aided or abetted
be submitted for grading (either an entire piece any form of academic misconduct are
 of work or a part) Giving material to another subject to the same procedures and
student that could be submitted for assessment penalties as the students who would benefit
will count as aiding and abetting, as will the offer from the offence)
to provide material whether or not it is accepted
by another student (for example, advertising an
essay-writing service).
6 Theft and presentation of another student's a) Cancellation of the candidate's
work examination results in the unit concerned.
b) Suspension from the
c) University for one academic year (three
trimesters/ two semesters)
d) Repeat the unit upon resumption with full
payment.
7 Signing the class attendance sheet for another a) Suspension from the University for one
student academic year
b) Repeat the unit upon resumption with full
payment
8 Taking information (including notes in any a) Cancellation of the examination results in
format, books, electronically stored data or the unit
illegitimately annotated copies of dictionaries, b) Suspension of the candidate from the
set texts, annotations made on calculators or university for one trimester /semester
concealed on parts of a student's body or in any c) Repeat the unit upon resumption with full
format including seats and walls. payment
9 Copying from unauthorized material carried a) Cancellation of the examination result in
by the candidate himself / herself or any other the unit
person(s) to the examination venue b) Suspension of the candidate from the
university for one trimester/semester
c) Repeat the unit upon resumption with full
payment
10 Circulation of unauthorized written material to Expulsion from the university
other candidates during an examination and or
exchange of any written material including
examination question papers.
11 Writing on the examination question paper as a a) Cancellation of the examination results in
form of rough work. the unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment
12 Taking mobile phones, digital smart watches, a) Cancellation of the examination results in
smart pens, smart calculators and any other the unit
electronic device into the examination b) Suspension of the candidate from the
university for one trimester/semester
c) Repeat the unit upon resumption with full
payment
13 Communicating orally with other candidates a) Cancellation of the examination results in
during the examination. the unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit, with full payment
14 Copying from other candidates examination a) Cancellation of the examination results in
work in the examination. the unit
b) Suspension of the candidate from the
university for one trimester/semester
c) Repeat of the unit upon resumption, with
full payment
15 Impersonation or attempted impersonation of a) Expulsion from the university for the
candidate during examination or course work candidates involved in the conspiracy

16 Unauthorized and undeclared acquisition of a) Discontinuation of Studies

examination questions prior to an examination, Expulsion from the university with no
whether or not that examination is be sat bythe grades, certificate, diploma or degree
student concerned awarded
17 Possession of used or unused examination a) Cancellation of the examination results in
answer book (s) in the examination venue the unit
during examination other than the material issued b) Suspension of the candidate from the
by the invigilator. university for one academic year (three
trimesters/two semesters)
Repeat the unit upon resumption with full
payment
18 Failure to return (hand-in) examination booklet Expulsion from the university
after examination

19 Returning of examination answer books with a) Cancellation of the examination results of

written answers after the time allowed and the unit concerned.
specified by invigilator. b) Repeat the unit with full payment
20 Willful disruption of University examinations a) Expulsion from the university
and causing commotion during examinations

21 Failure to comply with invigilator's a) Cancellation of the examination results in

instructions causing unwantedattention. the unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment
22 Presenting oneself for an examination in a unit a) Cancellation of the examination results in
no duly registered the unit
b) Suspension of the candidate from the
university for one trimester/semester
c) Repeat the unit upon resumption with full
payment
23 Presenting oneself in multiple a) Cancellation of the examination results in the
examinations for the same unit duringthe unit
same examination period b) Suspension of the candidate from the
university for one trimester/semester
c) Repeat the unit upon resumption with full
payment
24 Commission of examination offenses more a) Discontinuation of Studies — Expulsion from
than once. the university with no grades, certificate,
diploma or degree awarded
25 Any unauthorized absence of a candidate a) Cancellation of the examination results inthe
from the examination room during the unit
period of an examination b) Repeat the unit with full payment
26 Threatening the invigilator and obstructing a) Cancellation of the examination results in the
the invigilator fromcarrying out his/her unit
duties. b) Suspension of the candidate from the
university for two academic years (six
trimesters/four semesters).
c) Repeat the unit with full payment.
27 Causing actual bodily harm to either the Expulsion from the university
invigilator or those assisting in the invigilation
or fellow candidates sitting the examination.
28 Forgery of examination marks, grade(s), a) Cancellation of the examination results r inthe
examination card unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment

29 Forgery of University certificate, letter Expulsion from the university

of completion or official transcript
30 Bribery so as to compromise examination a) Cancellation of the examination results in the
credibility unit
b) Suspension of the candidate from the
university for three academic years. (nine
trimesters/six semesters)
c) Repeat the unit upon resumption with full
payment
31 Possession and/or usage of another a) Cancellation of the examination results in the
candidate's examination card. unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment
32 Availing ones examination card for use by a) Cancellation of the examination results in the
another candidate. unit
b) Suspension of the candidate from the
 university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment
33 Presenting an invalid examination card to a) Cancellation of the examination results in the
the invigilator during anexamination. unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment
34 Possession of a forged examination card. a) Cancellation of the examination results in the
unit
b) Suspension of the candidate from the
university for one academic year (three
trimesters/two semesters)
c) Repeat the unit upon resumption with full
payment

NB: Students should be familiar with all rules relating to computer labs, Examinations and library in the respective
departments. Remember ignorance is no defense hence each student should make an initiative to get in touch with
all necessary information while at the University from the respective Deans and the University Registrar.

I have read and understood the University rules and accepted the regulations for the good order and
governance of the university.

Student Name: ………………………………………………………...........................................................................

Date: ………………………………………………… Signature: …………………………………………................

Parent/Guardian’s Name: ……………………………………………. Signature: …………………………………...

Parent/Guardian’s Contact: ………………………………………...... Date: ………………………….......................