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Personal Details Form

This document is a personal details form for students at Tharaka University, required for establishing a complete record in the office of the Registrar (Academic Affairs). It collects essential information such as full name, national ID, admission number, date of birth, contact details, and family information. The form must be completed in quadruplicate and includes sections for official use by the university staff.

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802 views2 pages

Personal Details Form

This document is a personal details form for students at Tharaka University, required for establishing a complete record in the office of the Registrar (Academic Affairs). It collects essential information such as full name, national ID, admission number, date of birth, contact details, and family information. The form must be completed in quadruplicate and includes sections for official use by the university staff.

Uploaded by

josshuajunior
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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TUC/ADM/FORM/1

THARAKA UNIVERSITY
P.O BOX 193-60215, Telephone :|+(254)-0202008549,
MARIMANTI, KENYA +(254)-02020076920
email: info@tharaka.ac.ke
Website: https://www.tharaka.ac.ke

COLLEGE
(A Constituent College of Chuka University) AFFIX
OFFICE OF THE REGISTRAR (ACADEMIC AFFAIRS) PASSPORT

STUDENT’S PERSONAL DETAILS

Information provided in this form is essential in establishing a complete record of the student in the office of
the Registrars (Academic Affairs).
(To be completed in quadruplicate and capital letters, spelling all names in full)

1. Full name (As it appears in ID/Birth Certificate)


……………………………………………………………………………………………………………
First Middle Last / Surname
2. National ID No. or Birth Certificate No. : …………………………………Telephone…………………

3. University Admission Number: ………………………………Year of Study: …………………………

Course of Study: ……………………………………….Student email address……………………………

4. Date of Birth: …………………………………Religion: ………………………………………………

5. Home Contact Address: ……………………………………………………………………………………

6. Marital Status: ………………………Spouse & Telephone (if Married): …………………………………

7. Full Name of Mother: …………………………………………………………Deceased /Alive (tick one)

8. Full Name of Father: …………………………………………………………..Deceased /Alive (tick one)

9. Full name of Guardian (if neither 7 nor 8)…………………………………Telephone …………………..

10. (a) Occupation of the Father: ………………………………………………….Deceased /Alive (tick one)

Contact: Telephone Number…………………………………………………

(b) Occupation of the Mother: …………………………………………………Deceased /Alive (tick one)

Contact: Telephone Number…………………………………………………

(c) Occupation of Guardian (if neither (a) or (b): …………………………Telephone ……………………

1
TUC/ADM/FORM/1

11. Name of brother(s) and sister(s) and addresses (Attach additional sheet of paper if necessary)

…………………………………………………………………………………………………………………

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

12. Place of permanent residence: Village……………………………………………………………………..


Nearest town…………………………Location ………………………..Name of Chief:…………………….
Chief’s Signature……………………….Chief’s telephone ……………………Chief’s stamp……………..
Name of Assistant Chief: ………………………………..Telephone …………………………………………
Sub- County: ……………………………………………...County: …………………………………………..
Name of County Commissioner: ………………………………………………………………………..
County Commissioner’s Signature…………………………………………………Date: ……………………

Official Stamp: …………………………………….

13. Place of birth (if Different from 12 above)


Village: ……………………………………Name of Chief: …………………Telephone ……………………
Location: ………………………………………Sub- County: ………………………………………………...
County: …………………………………………………………………………………………………………

FOR OFFICIAL USE ONLY


Name of Dean of the Faculty/Registrar (Academic Affairs): …………………………………………….......
Signature: ………………………………………….. Date: ……………………………………………………

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