Students Registration Form

Online Application Form

Please fill out the application form carefully and completely

Basic Information
Full Name *

First Name Middle Name Last Name
Gender *
Birth Date *

Month Day Year
Course/Programme Applying for: *
for Incoming A.Y. '12-'13
Mode of Study *
E-mail *
ex: webmaster@gluk.ac.ke
Phone Number 1 *

- Country Code Phone Number
Phone Number 2

- Country Code Phone Number
Student Index Number/National ID
e.g. 11183021
County of Residence
for Incoming A.Y. '12-'13
Marital Status
Nationality *
Religion

Present Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Person to contact in case of emergency: *
Parent/Guardian - (Phone Number)
Relationship *
ex. Father, Mother, etc.

Academic Background
High School Name *
Mean Grade *
Academic Certs
File should be in pdf, doc/docx format.
Mathematics
English
Kiswahili
Physics
Chemistry
Biology
Geography
History
Agriculture
CRE/IRE
Business
Other Subject (please indicate the subject with the grade)
Extra Curricular Participation

Student Council Class Officer Club/Organization Varsity Player Others (please specify below)
Bank Slip Attachment
File should be in pdf, doc/docx format.

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