REVISED- JUN 2022

MSc/MBA & POSTGRADUATE COURSE APPLICATION FORM

Complete all appropriate sections in block letters and return with your non-refundable application fee, copies and originals of
your certificates and other supporting documents to: Office of the Registrar, KCA University, P. O. BOX 56808-00200, NAIROBI
KENYA. TEL: +254715532187 / +254792793056 / +254710888022 / +254722869917/ 020 8070408/9 /FAX: 254020-8561077
E-mail: registrar@kcau.ac.ke Website: www.kcau.ac.ke
AFFIX 2
RECENT

PASSPORT

PHOTOS

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 Yes
admission: No
(Refer to Page 4 for details)

Mailing Address/ Contacts

P.O. Box / Postal Code / Town Mobile No(s). Tel No. (office/house) Email Address
a)
/ / b)

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

Name ………………………………………………………… Relationship to applicant…………………………………………...
P.O. Box ……………........ Postal Code …………………… Town…………….…………………………………………………
Telephone...………………………………………………….. Email address…….………………………………………………...
Course Name (Tick where appropriate)
Master of Science (MSc) Master of Business Administration (MBA)
MSc. Commerce MBA Specialization
Marketing Post Graduate Diploma
MSc. Development Finance in Education
Human Resource Management
MSc. Knowledge Management & Innovation Procurement & Supplies Management
MSc. Data Analytics MBA Corporate Management
MSc. Information Systems Management
Master of Education
Master of Arts Administration, Curriculum and Policy Studies
Master of Arts Counseling Psychology Leadership and Management

Page|1
Preferred Intake / Year: _______________________ Mode of Study:

January May September Part time Weekend Distance Learning.

Campus: Main / Ruaraka City Centre / Town Kitengela Western

How do you intend to finance your studies?

Personal Savings Company Sponsorship

Contacts (Tel/Mobile): ..........................................................

Have you previously registered with KCA?

Yes No If yes, gives your KCA Reg. Number

Education (please list last colleges or universities attended)

Name Period attended

(School/College) From To Course/Education Grade/Award

(Level attained e.g. diploma, degree)

College/University
a).

b).

c).

Current Employer Details

Company Name Position Work Experience Address

(Title) (Duration)
…………………………………… ………………………………… …….………………… ………..........................................

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

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

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

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

Relatives who have attended KCAU (if any)

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

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

Page|2
 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 KCAU alumnus/alumni

Other (specify) …............………

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

1. National ID or Birth Certificate

2. O level Certificate or Result Slip
Certified & Processed
3. Academic Certificate and Transcripts
4. Current Detailed CV
Officer..............................
5. Recommendation Letter from Employer

• In addition, applicants should bring; Sign...................................

6. Two Colour Passport-Size Photographs

Date...................................
• Application fees (Kshs 3000) can be deposited in one of the following KCAU bank accounts:
Bank Code Account No. Bank Name
- 002 010 200 117 1100 Standard Chartered Bank - Ruaraka
- 073 135 217 8 ABSA Bank – Westlands
- 007 643 228 001 5 NCBA – Wabera Street

ORIGINAL DEPOSIT SLIP must be attached to the application form when forwarding to the admissions office. You can also
pay by MPESA upon verification of documents by the admissions office.

ATTESTATION

I hereby certify that the information given in this application is correct and complete to the best of my knowledge, and hereby
give my permission to the Admissions Office to obtain any verification deemed necessary to process my application. I further
certify that attached are true copies of my official transcripts as requested, and that the copies become the property of the
university. I include with this application form the official payment receipt /Bank deposit slip for the application fee and copies
of other documents as stated in the application requirements.

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

Thank you for choosing to study with us!

Page|3
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
minimized. 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 carer 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@kcau.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: …………………................................................

Page|4