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* 3. Mailing Address a. Address (Number ONLY) b. Code c. City
d. Country
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* 4. Mailing Address you will be using while in college a. Address (Number ONLY) b. Code c. City
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* 5. Physical Address * 6. Email Address
7. Marital Status
Married Divorced Widowed Single I prefer not to mention
8. Date of Birth a. Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 b. Month January February March April May June July August September October November December c. year 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975
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9. Home Phone Number 10. Country of Birth 11. First Language English, Swahili , French, German , Other 12. Country of Citizenship FAMILY INFORMATION 13. Who will you be living with while studying here Mother Father Both Neither
Parent/ Sponsor 14. Parent/Sponsor's Names 15. Parent/Sponsor's Address 16. Parent/Sponsor's City 17. Parent/Sponsor's Country 18. Parent/Sponsor's Place of work 19. Parent/Sponsor's Work Phone Number 20. Parent/Sponsor's Email ........................................................................................................................................... Guardian 21. Guardian's Names 22. Guardian's Address 23. Guardian's City 24. Guardian's Country 25. Guardian's Place of work 26. Guardian's Work Phone Number 27. Guardian's Email ........................................................................................................................................... Emergency Contacts (Person to contact in case of an emergency ) 28 Names 29. Relationship to you 30. Telephone Number a. Day b. Night 31. Mailing Address 32. City 33. Country ...................................................................................................................................................................... 34. Your Gender Female Male ........................................................................................................................................................................ EDUCATION BACKGROUND Schools you attended School 1 36. Name 37. City 38. Country 39 . Dates ..................................................................................................................................................................... School 2 40. Name 41. City 42. Country 43 . Dates ..................................................................................................................................................................... 44. How did you learn about us
