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POST GRADUATE APPLICATION FORM

INSTRUCTIONS In order to e considered for the post graduate programmes, complete the application form and return it to The Management University of Africa accompanied by the following: copy of national ID/passport, two passport size photos, Certified copies of your certificates, 2 recommendations from your professional referees and current CV.

SECTION A: PERSONAL INFORMATION Full Names (Block Letters)-------------------------------------------------------------------------------

(Last)

(First)

Male ----------------- Female -------------------

(Middle )

Nationality ---------------------------

Date of Birth -------- /--------- /--------- ID No. /Passport -----------------------------Permanent Address. P.O. Box --------------------------------------------------------------Tel: Daytime -------------------- Evening ---------------------- Cell phone -------------E-mail Address --------------------------------------------------------------------------------If Employed/Consultant Business Address: Company’s Name ------------------------------ P.O Box ------------- --------------------Town ------------------------- Tel ------------------------------- Fax --- -----------------Next of Kin (Emergency Contact) Name ---------------------------------------------- Relationship -------------------------Address ----------------------------

Tel: Daytime --------------------------------------Evening ----------------------------------------Cell phone --------------------------------------

Name of sponsor -------------------------------------------------------------------------Address ----------------------------------------------------- Signature ----------------

WHICH COURSE ARE YOU APPLYING FOR? 1. Executive Master of Business Administration(EMBA)

Preferred days of class attendance: a) Evening (Mon, Tue & Wed) b) Weekend (Fri & Sat)

2. Executive Master of Science in Applied Management and Leadership (MSc AML)

SECTION B: ACADEMIC/PROFESSIONAL QUALIFICATIONS COLLEGE/UNIVERSITY

CERTIFICATE/DIPLOMA/DEGREE

(Attach certi ed testimonial copies. Use additional sheet of paper if needed)

YEAR OF STUDY


SECTION C: WORK EXPERIENCE NAME OF ORGANIZATION

POSITION

HELD

Use additional sheet of paper if needed

SECTION D: NAMES AND ADDRESS OF REFEREES

DATES

(Employment related)

First Referee Name: -----------------------------------------------

Address -------------------------------------------

Tel: -------------------------------------------------Second Referee Name: ------------------------------------------------

Address --------------------------------------------

Tel: -------------------------------------------------Third Referee Name: ----------------------------------------------

Address --------------------------------------------

Tel: --- ------------------ -----------------------------

SECTION E: DECLARATION I understand that withholding information requested on this application or giving false information may make me ineligible for admission into the programme or subject to dismissal. With this in mind, I certify that the above statements are correct and complete and if admitted, I agree to abide by the published policies and regulations of the Institutions. I further understand that from the time I le my application with the Institutions, it is my responsibility to know the rules, requirements for my intendedExecutive MBA Program. (In order to be reviewed, this application must be signed, dated and accompanied by a non refundable fee of Ksh. 2, 000 application fee Signature ---------------------------------------------------

Date ----------------------------------

SECTION N E: E FOR OFFICIAL USE ONLY Course -------------------------------------------

No. Of units -------------------------------------------

Admission No : ---------------------------------Signature ----------------------------------------

Application fees payable to: Management University of Africa Barclays Bank of Kenya South C, Red Cross Branch Account Number: 2023842818

Date received -----------------------------------------


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