KIBOGORA POLYTECHNIC
UNDERGRADUATE STUDIES - APPLICATION FORM
Type or print in capital letters. If you type, you can copy this tick symbol √ in place of the tick boxes below.
The completed form must be submitted to the Registrar’s Office at Kibogora Polytechnic.
Emailed applications are accepted but this completed form and scans of all documents requested must be
attached to the email, addressed to kibogorapoly@gmail.com / info@kp.ac.rw ALL documents will be
verified in person at Registration if your application is successful and it is your responsibility to bring
them to Registration.
A non-refundable application fee of 5000RwF must be paid into the university’s Bank account no:
BPR: 493326027410185; Equity Bank: 0001501341070500; BK: 100005702369,
UMWALIMU-SACC0: 9010665700
The application will not be processed unless a photocopy of the bank slip/receipt is attached to the
completed application form.
PART A: YOURSELF
Surname(Family Name):
First name:
Mother ‘s Name:
Father ‘s Name:
Date of Birth:
Marital Status (please tick one only) Married □ Single □ Divorced □ Widowed □
Gender : Male □ Female □
Nationality: ID No/Passport No:
Health Insurance:
Religion:
Home Address: Province:
District: Cell:
Sector: Village:
Telephone number (for SMS):
Email:
Nb applicants must have SMS and/or email address, otherwise the application cannot be processed
Alternative Contact Person: Name and Number for SMS:
Do you have any special needs or disabilities? Yes □ No □
If yes, specify
PART B: YOUR APPLICATION: What program option are you applying for?
PROGRAM
1. Faculty of Health Science 3. Faculty of Business development studies
a) General Nursing(A1) □ a) Economics and Management □
b) General Nursing(A0) □ b) Rural Development □
c) Midwifery (A1) □ c) Accounting □
d) Midwifery (A0) □ d) Finance□
e) Laboratory Sciences(A1) □ e) Cooperatives and Small Business
Management □
f) Laboratory Sciences(A0) □
g) Dental Therapy(A0) □ Professional Courses:
h) Anesthesia (A0) □ Certified Accounting Technicians(CAT) □
2. Faculty of Education
Certified Public Accountant(CPA) □
a) Humanities: Geo-History □ 4. Department of theology
Economic-Entrepreneurship □
b) Languages: English- French □ Bachelor of Arts in Theology □
English – Kiny □ Post Graduate Diploma in Theology □
English -Swahili □
c) Sciences: Mathematics-Physics □
Biology-Chemistry □
d) PGD (Post Graduate Diploma in Education)
What Level are you applying for? :
MODE OF STUDY (please tick one only) Day Time □ Evenings □ Weekend □ Holiday
□
Intake: Academic Year:
If this program/mode/start date is unavail able, what is your alternative choice?
PART C: YOUR ACADEMIC RECORD
List schools, colleges and higher institutions attended, beginning with the most recent.
Attach certified photocopies of certificates and transcripts obtained from Level 5 onwards.
Name and Address of From To Subjects Grade Award/Diploma
School/College/HLI Obtained
