First Name *
Family Name *
Date of Birth *
Address *
Correspondence Address (if different from permanent address)
P.O. Box
Country of Residence:
Nationality
Mobile Number *
E-mail Address *
Programme Title * Advanced Diploma in Software Engineering (ADSE)Advanced Diploma in Multimedia (ADIM)Diploma in Multimedia (DIM)Diploma in ITCertificate in Multimedia (CIM)Certificate of Proficiency in Information System Management (CPISM); Digital Marketing CourseMicrosoft Office Specialist 2013
Intake Year * September 2018January 2019
Visa Services(If Required)
Special Needs (EICN encourages you to disclose any disability/medical condition which could disadvantage your ability to study. All offers are made on academic grounds only and the information you submit will be used to help EICN* provide appropriate support. Please choose all that apply. NB: Hold Control Key then click to choose Multiple No DisabilityBlind/Partial SightedWheelchair User/Mobility issues. Mental Health DifficultiesAutistic Spectrum / Asperger’sDyslexiaDeaf/Hearing ImpairmentEpilepsyUnseen Disability: E.g. DiabetesOthers.
Please Detail Other Disability or Additional Support Needs:
Detail of Qualification
If you previously studied at University of Northampton, Please enter Student ID :
Please enter your Highest Level of Education: Eg: BSc/MSc/A-level:
Name of Institution and Country:
*NB: EICN-Edulink International College Nairobi
Please list all qualifications in chronological order with the most recent first. Provide copies of certificates and transcripts where appropriate. If not accompanying this form, please ensure that any documentation is submitted along with the appropriate downloadable cover sheet.
Note: Print outs from self-service / web portal systems will not be accepted. The documentation submitted must be formally issued by the relevant awarding institution/exam body.
International students must submit documentation both in the original language and as an officially endorsed English language translation.
Educational Qualifications – State most recent first, attaching copies of certificates and transcripts where possible. For International students, these should be in both the original language and an official English translation. Please do not send original certificates.
University, School, College Name and Address
Degree, Diploma, Certificate A-level,10th Grade,12th Grade, KCSE, etc.
Subject(s)
Grade/Division/Class
Date Started and Date Awarded
Exam Status Exams yet to be takenResults awaitedExams yet to be taken
Language Qualifications:
Entry is conditional on the achievement of a standard level of English. If your first language is not English then please give details of the most recent English Proficiency course you have taken. Eg: IELTS, TOEF)
Qualification Name:
Grade Achieved
Award Date
Professional Qualifications
Please provide details of any professional qualifications which you have gained, or memberships of any professional bodies.
Qualification Details:
Results achieved:
Award Date:
EMPLOYMENT AND WORK EXPERIENCE (Alternatively attach a detailed updated CV/Resume with references )
Employers Name and Address
Role and Brief Description of Duties
Full Time or Part Time? Full TimePart Time
Dates Employed:
Any statements on this form which prove to be untrue or purposely misleading will render the application void. Furthermore, if inaccuracies are highlighted at a later stage we retain the right to retract any offer made or expel the student with no refund of fees.
I accept and grant permission for my employer/sponsor to be informed of any relevant information relating to progression of my programme, including my record of attendance.
I confirm that the information given on this form is true, complete and accurate. No information requested or other material has been omitted. I consent to the storage and processing of data by Edulink International College, Nairobi.
Accept *
