TUC/2A

TURKANA UNIVERSITY COLLEGE

TEL: +254(0789399751) or
+254(0724178505) P.O BOX 69-30500
Email- turkanauniversity@gmail.com LODWAR
Email-registrar.aa@tuc.ac.ke KENYA
Website - www.tuc.ac.ke KENYA
Office of the Dean of Students
BOND

I,……………………………………………………………….Registration Number………………………………..
(FULL NAME)

I hereby bond myself to be of good conduct during my stay at the Turkana University College

I also bond myself to abide by all the University Rules and Regulations as contained in the Student Guide.

Failure to adhere to the above, the Turkana University College will reserve the right to institute disciplinary
procedures against me.

Signed:…………………………………………………………………………Date:………………………….………

Signed: …………………………………………………

(Dean of Students)

Rubber Stamp………………..…………………………
 TUC/2B

TURKANA UNIVERSITY COLLEGE

TEL: +254(0789399751) or . P.O BOX 69-30500

+254(0724178505) Email- LODWAR
turkanauniversity@gmail.com Email- KENYA
registrar.aa@tuc.ac.ke
Website - www.tuc.ac.ke

Games and Sports Department

PERSONAL INFORMATION ON SPORTING AND GAMES ACTIVITIES

Name:…………………………………………………………………………………………………

Reg No.:…………………………………….… Campus:……………………………………………

Tel. No.:………………………………………. Email No:…………………………………………..

Indicate by a tick (√) the game/sport you have participated in or of your interest

LEVEL OF PARTICIPATION

NO. GAME Zonal County Province National International Sport/Game of Interest

1 Soccer

2 Netball

3 Volleyball

4 Handball

5 Rugby

6 Athletics-
track/field

7 Basketball
8 Chess,

Scrabble,

darts

9 Tennis

10 Martial arts

11 Swimming

12 Hockey

13 Badminton

14 Table tennis

OTHERS

Signed……………………………………………………………………… Date…………………………………………………
 TUC/3
AFFIX
COLOURED
TEL: +254(0789399751) or P.O BOX 69-30500
LODWAR PASSPORT SIZE
+254(0724178505) Email-
turkanauniversity@gmail.co KENYA PHOTO HERE
m Email-
registrar.aa@tuc.ac.ke
Website - www.tuc.ac.ke

TURKANA UNIVERSITY COLLEGE

Office of the Registrar (Academic Affairs)

STUDENTS PERSONAL DETAILS

Information in this form is intended to help the Office of the Registrar understand the student better. It will be used for purposes of improving the Student’s
Welfare While at the University (To be completed in Duplicate and written in CAPITAL/BLOCK letters or TICK where appropriate)

1 Name

Surname First Name Initial/Other

2. National Registration Number (I/D) County

3. University Registration Number

Year of Study 1. First 2. Second 3. Third 4 Fourth 5.Fifth

4. Date of Birth.

Day Month Year

Specify: ______________
5. Religion 1. Protestant 2.Catholic 3. Muslim SDA. 4. Others

6. Nationality 1. Kenyan 2. East African 3. Others Specify ______________ __________

 7. Home contact address (where you can be contacted during vacations)

P.O. BOX CITY/TOWN

TELEPHONE (LANDLINE) MOBILE PHONE (S) E-MAIL ADDRESS

8. (a) Marital Status 1. Single 2. Married

(b) Name and Address of Spouse (if married)

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

P.O. BOX CITY/TOWN

TELEPHONE (LANDLINE) MOBILE PHONE E-MAIL ADDRESS

9. (a) Full Name of Father:

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

Deceased Alive Occupation

Date of Birth

Day Month Year

(b) Full Name of Mother:

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

Deceased Alive Occupation

Date of Birth

Day Month Year

10. (a) Full Name of Guardian

(SURNAME) (FIRST NAME) (INITIAL/OTHER

(b). Occupation of Guardian

I/D No.
 11. Address of Parent/Guardian

P.O. BOX CITY/TOWN

TELEPHONE (LANDLINE) MOBILE PHONE E-MAIL ADDRESS

12.(a) Name of Next of Kin

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

(b) Address of Next of Kin

P.O. BOX CITY/TOWN

I.D. NO.
.

TELEPHONE (LANDLINE) MOBILE PHONE E-MAIL ADDRESS

13. Place of Birth: Village ______________

Location ____________ ___________________ Name of Chief ______________

Division ____________ County _____________Constituency ______________

14. Place of Permanent Residence:

Village __________________Nearest Town _____ ___________Nearest Police Station _____________

Location _______________Name of Assistant Chief _______Name of Chief _________________________________

15. Give names and addresses of two persons who can be contacted in case of emergency.

(i)

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

RELATIONSHIP P.O. BOX TOWN/CITY

TELEPHONE (LANDLINE) MOBILE PHONE E-MAIL ADDRESS

(ii)

(SURNAME) (FIRST NAME) (INITIAL/OTHER)

 RELATIONSHIP P.O. BOX TOWN/CITY

TELEPHONE (LANDLINE) MOBILE PHONE E-MAIL ADDRESS

NAME ADDRESS TOWN DATES

FROM TO

1.

2.

3.

16. Name and address of Secondary School attended:

17. KCE/KCSE or equivalent Results (Subjects & Grades)

Mean Score/Division (where applicable)

18. Name and address of School attended for KACE/”A” Level (Where applicable)

(a) Name

(b) Address P.O. BOX TOWN/CITY

19. KACE Results/”A” Level Results (Subject and Grades)

20. Any other Institutions attended and Qualifications attained

NAME SPECIALIZATION QUALIFICATIONS

1.

2.

3.

21. Games/Sports: Which games and Sports do you participate in:

 01. Soccer 02. Hockey 03. Basketball 04. Netball

05. Tennis 06. Badminton 07. Rugby 08. Volleyball

09. Athletics 10. Swimming 11. Table Tennis 12. Darts

13. Karate 14. Martial Arts 15. Others

If you represented your school, etc. in games please give details:

___________________

22. Clubs and Societies: Which clubs and societies are you interested in:

Please give details of your application.

(a) First Choice

(b) Second Choice

( c ) Third Choice

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

No. Yes

________

24. 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:
 TURKANA UNIVERSITY COLLEGE
TEL: +254(0789399751) or +254(0724178505) P.O BOX 69-30500
Email-registrar.aa@tuc.ac.ke LODWAR
Email- turkanauniversity@gmail.com KENYA
Website - www.tuc.ac.ke

Office of the Registrar (Academic Affairs)

ENTRANCE MEDICAL EXAMINATION

IMPORTANT
Students are requested to complete Part 1 of this Form. Part 11 should be filled by a Certified Medical Practitioner at a

Government Hospital. The completed Form should be brought personally and presented to the Medical Registration Officers

on the day of Registration by the student. No medical reports should be brought earlier or sent by post.

PART 1

(a) Surname………………………………Other Names ………………….………………………………………………………………

Date and place of birth ………………………Sex…………………….Nationality……………………Race……………………
Religion………………………………………… Marital Status………………………………………………….…………………...

Faculty/School/Centre……. …………………………………………Registration Number…………………………..……………

Name, Address, and Telephone Number of Parent/Guardian/Next of ………………………………………………………..…

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

(b) Have you ever been admitted in a hospital? ..……………………………………………………….……………………………

If so, state reason for admission and date…………………………………………………………………….……………………

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

(c) Have you had any of the following illness:

(i) Tuberculosis or other chest infection? ………………………………………………………………………………Yes/No

(ii) Fits, Nervous disease or fainting attacks?…………………………………………………………………………..Yes/No

(iii) Heart disease or Rheumatic fever? ………………………………………………………….………………………Yes/No

(iv) Any disease of the digestive system? …………………………………………………………………………….Yes/No

(v) Any disease of Genito Urinary System? ………………………………………………………………………….Yes/No

 (vi) Allergies to food or drugs ………………………………………………………………………….…………….….Yes/No

(vii) Malaria?……………………………………………………………………………………………….………………Yes/No

(viii) Sexually Transmitted Disease? ………………………………………………………………….…………………Yes/No

(ix) Poliomyelitis? …………………………………………………………………………………….…………………..Yes/No

If the answer to any of the above is Yes. Please give details with dates………………………………….…………………

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

(d) If there are any other relevant details of your medical history not covered by the above questions please give
particulars……………………………………………………………………………………………………………………………………
...............................................................................................................................................................................................
(e) Has any member of your family suffered from:
(i) Tuberculosis? ………………………………………………………………………………………………………….Yes/No

(ii) Insanity or Mental illness? ………………………………………………………………………….…………………..Yes/No

(iii) Diabetes Mallitus? …………………………………………………………………………………..……………………Yes/No

(iv) Heart disease? ………………………………………………………………………………………..…………………Yes/No

(f) Have you been immunized against any of the following diseases:
(i) Smallpox? Yes/No ………………………………… Date……………………………………………

(ii) Tetanus? Yes/No ………………………………….. Date……………………………………………

(iii) Poliomyelitis? Yes/No …………………………….. Date…………………………………………….

(iv) Tuberculosis? Yes/No ……………………………… Date…………………………………………….

(v) Typhoid? Yes/No …………………………………… Date……………………………………………

(vi) Hepatitis B? Yes/No……………………………….. Date……………………………………………

Signature of Student: ____________________________Date:

PART 11

(To be completed by the Examining Medical Officer)

(a) Height…………………………………………………………..Weight………………………………………………………………
(b) Visual Acuity:
Without glasses R.6/………………………………………. L./6……………………………………

With glasses R.6/……………………………………….. L./6……………………………………

(c) Hearing: Right Ear………………………………… Left Ear………………………………

(d) Condition of:

Teeth: ……………………………………………………Nose: ……………………………………………………….………….

Throat: ………………………………………………………………………………………………………………………..……
(e) Lymphatic glands……………………………………….…………………………………………….……………………….……………
(f) Circulatory System………………………………………………………Pulse…………………….……………………………………
Blood Pressure……………………………Systolic……………………Diastolic………………………………………………………

(g) Respiratory System…………………………………………………………………………………………….………………………

(h) Abdomen……………………………………………………………………………………………………………………………
Spleen……………………………………………………………………………………………………………………..………………

Any evidence of Hernia…………………………………………………………………………………..…………………………

Any evidence of Haemorrhoids…………………………………………………………………………….…………………………..

(i) Urine…SG…………………………….Albumin………………………….Sugar……………………………………………….………
(j) Any observable physical defects in addition to general record of observation:
If any please specify………………………………………………………………………………………………..………………………

(k) Is the student on any treatment………………………………………………………………………………………………….....

If any please specify……………………………………………………………………………………………………………………

(l) Blood KhanTest / VDRL…………………………………………………………………………………..…………….………………….

(m) Any other observation of importance…………………………………….………………………………………………………………

Medical Officer: ……………………………………………………

Address: ………………………………………………………………………………………………Stamp& Date:………………………

PART III

(To be completed by the University Chief Medical Officer)

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

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

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

Is the Student fit for University Education? Yes/No

Medical Officer……………………………………………….… Date:……………………………………

FOR TURKANA UNIVERSITY COLLEGE.
 T

TURKANA UNIVERSITY COLLEGE

CUSTOMER SURVEY FORM FOR NEW STUDENTS
A) Notice to All New Students
1. This form will be used by the University Management to improve services to customers.
2. Please tick in the box in front of the right answer or answer the question as appropriate.
B) Questionnaire
1. State the School to which you have been admitted……………………………………
…………………………………..
2. State to programme to which you have been admitted (e.g. B.Ed (Arts)
……………………………………………..……………………
3. State your gender: Male [ ] Female[ ]
4. State your type of sponsorship: Government Sponsored [ ] Self sponsored[ ]
5. When did you hear about Masinde Muliro University of Science and Technology (TUC) for the first time? In
primary School [ ] In Secondary school [ ] After competing secondary school studies [ ]
other (please specify)……………………………………….
6. Through which channel did you get to know about TUC? Radio advert [ ]
Television advert [ ] Show and/Exhibition [ ] Sports/Extra-curricula activities [ ] Other [ ]
(please specify)……………………………………………………
7. Specify the most popular academic programme offered at TUC
8. that you know about……
………………………………………………………………………………………………………….
9. Did you choose to come to study at TUC? Yes[ ] No[ ]
10. (a) Do you have a relative who is a student at TUC? Yes [ ] No [ ]
(b) If yes, please state the nature of the relationship Parent [ ] Sister/Brother [ ] Cousin [ ]
Uncle/Aunt [ ] Grandparent [ ] Neighbour [ ] Friend [ ]
11. State the following: County of Origin……………………….. County of Residence……………. Sub-county
of Residence…………………………………………
12. How did you obtain your admission letter? Through Post Office [ ] From the TUC website[ ]
Collected by self [ ] Collected by relative/friend/neighbour[ ] Other [ ] please
specify……………………........................................................................................................
13. Was your admission letter processed on time? Yes[ ] No[ ]
14. State the TUC Campus that you were admitted to ……………………………… ……………..
15. State a) the TUC Campus of your choice and why: Campus…………………………………….
b) Why is it your choice? …………………………………………………………………………………….

Thank you for taking your time to respond to the questions that will assist TUC to serve you better.
We wish you all the best in our studies at TUC