ONLINE APPLICATION FORM 1. PERSONAL DETAILSSurname/Family Name *Other Names *Gender *selectMaleFemaleNationality *ID/Passport No. *Date of Birth *CountySub-Countyphone No. *EmailPhysical Address2. CERTIFICATE/DIPLOMA/DEGREE OF CHOICEState two (2) certificate/diploma/degree of choice for which you wish to be considered in order of preferenceFirst ChoicePhD in Community Health and DevelopmentPhD in Public HealthPhD in Agribusiness ManagementMaster in Community Health and DevelopmentMaster of Science in Public HealthMaster of Science in Community Nutrition and DieteticsMaster of Science in Clinical MedicineMaster of Science in NursingMaster of Science in Agribusiness ManagementMaster of Business AdministrationMaster of Arts in Counseling PsychologyMaster of Arts in TheologyBachelor of Science in Community Health and DevelopmentBachelor of Sc Community N DieteticsBachelor of Science in Public HealthBachelor of Science in Environmental HealthBachelor of Science in Clinical MedicineBachelor of Science in PhysiotherapyBachelor of Science in Medical Laboratory ScienceBachelor of Science in NursingBachelor of Science in Agribusiness ManagementBachelor of Science in Information TechnologyBachelor of Science in Hospitality and Tourism managementBachelor of Business AdministrationBachelor of Education (Arts)Bachelor of Education (Science)Bachelor of Arts in Counseling PsychologyBachelor of Pastoral TheologyDiploma in Community Health and DevelopmentDiploma in Community NutritionDiploma in Clinical Medicine and SurgeryDiploma in Agribusiness managementDiploma in Hospitality and Tourism managemenDiploma in Information TechnologDiploma in Business AdministrationDiploma in Counseling PsychologyDiploma TheologyCertificate in Community Health and DevelopmentCertificate in Community NutritionCertificate in Agribusiness managementCertificate in Hospitality and Tourism management Mean Grade D (Plain) and above 1 year (2 semestersCertificate in Information TechnologyCertificate in Business AdministrationCertificate in Counseling PsychologyCertificate in TheologySecond ChoicePhD in Community Health and DevelopmentPhD in Public HealthPhD in Agribusiness ManagementMaster in Community Health and DevelopmentMaster of Science in Public HealthMaster of Science in Community Nutrition and DieteticsMaster of Science in Clinical MedicineMaster of Science in NursingMaster of Science in Agribusiness ManagementMaster of Business AdministrationMaster of Arts in Counseling PsychologyMaster of Arts in TheologyBachelor of Science in Community Health and DevelopmentBachelor of Sc Community N DieteticsBachelor of Science in Public HealthBachelor of Science in Environmental HealthBachelor of Science in Clinical MedicineBachelor of Science in PhysiotherapyBachelor of Science in Medical Laboratory ScienceBachelor of Science in NursingBachelor of Science in Agribusiness ManagementBachelor of Science in Information TechnologyBachelor of Science in Hospitality and Tourism managementBachelor of Business AdministrationBachelor of Education (Arts)Bachelor of Education (Science)Bachelor of Arts in Counseling PsychologyBachelor of Pastoral TheologyDiploma in Community Health and DevelopmentDiploma in Community NutritionDiploma in Clinical Medicine and SurgeryDiploma in Agribusiness managementDiploma in Hospitality and Tourism managemenDiploma in Information TechnologDiploma in Business AdministrationDiploma in Counseling PsychologyDiploma TheologyCertificate in Community Health and DevelopmentCertificate in Community NutritionCertificate in Agribusiness managementCertificate in Hospitality and Tourism management Mean Grade D (Plain) and above 1 year (2 semestersCertificate in Information TechnologyCertificate in Business AdministrationCertificate in Counseling PsychologyCertificate in TheologyState Campus of PreferenceMain Campus (Kisumu)Nairobi CampusSpecify mode of studyFulltimePart-timeOnlineBriefly Explain the reasons for selecting this programme and how you expect to benefit in your future work3. ACADEMIC AND PROFESSIONAL QUALIFICATIONSlist all Schools/Colleges and Universities attended. Start with the most recent.Secondary School AttendedDate of CompletionGrade AttainedUpload KCSE CertChoose FileNo file chosenDelete uploaded filePrimary School AttendedDate of CompletionGrade AttainedUpload KCSE CertChoose FileNo file chosenDelete uploaded fileAny Other School Attended and Qualifications attainedHow did you come to know about Great Lakes University of KisumuUniversity WebsiteNewspaperTV/RadioInternetBrochuresFamily/FriendsUniversity StaffExhibitionsCareer visits/TalksOthers (Specify)DECLARATION *I certify that the information given in this application form is correct to the best of my knowledge. I acknowledge that providing incorrect information or withholding relevant information may result in the University withdrawing any offer of a place or during the course of studyName of ApplicantDateSUBMIT APPLICATION
