KENYA-SCHOOL-FOR-INTEGRATED-MEDICINE

Kenya School For Integrated Medicine

^{Application form}

SECTION 1: PERSONAL DETAILS

Name:

Postal Address:

Postal Code:

Town:

ID or Birth Cert or Waiting Card No: (Optional)

Gender:

Name Guardian or Parent:

Relationship:

Nationality:

County:

Email:

Phone 1:

Phone 2: (Optional)

SECTION 5: APLICATION FEE MODE OF PAYMENT.
Payment options

Mpesa:
- Paybill number: 716997.
- A/C No. Student name.
KCB KWALE BRANCH :
- A/C NUMBER 1172225893.
- A/C Student Name
Payment Amount :
- KES 1000

Mpesa Code / Cheque Number (Optional) SECTION 6: REFERRAL

Give name or number of the person who referred you:

SECTION 7: APPLICANTS DECLARATION.
I declare that the information given herein is true and accurate to the best of my knowledge and fully understand that any information found to be false will lead to automatic disqualification from consideration and/or prosecution.